A cross-sectional study of the impact of the COVID-19 lockdown on domestic violence-related oral and maxillofacial injuries.

BACKGROUND: During the COVID-19 lockdown, more domestic violence-related traumas were reported. In this study, we investigated and compared the incidence of domestic violence-related injuries-in particular oral and maxillofacial injuries-in Ulaanbaatar, Mongolia, before and during the COVID-19 lockdown. MATERIALS AND METHODS: We conducted a cross-sectional study based on 3974 domestic violence cases registered at the Public Health Department, National Traumatology and Orthopedics Research Center of Mongolia between 2018 and 2022. Descriptive and binary logistic regression analyses were conducted. The victims were categorized according to their age (child, adult, and elderly). RESULTS: The mean age of the victims was children 9.7 ± 5.4 years, adults 34.8 ± 8.3 years, and elderly 64.3 ± 8.7 years. Binary logistic regression analysis (no/yes) showed that oral and maxillofacial injuries during the lockdown increased 1.3 times (OR = 1.3; CI 95% = 1.0-1.6; p = .003) in adults and 2.5 times in children (OR = 2.5; CI 95% = 1.7-3.9; p = .001). Additionally, injuries to upper limbs increased 4.6 times (OR = 4.6; CI 95% = 3.5-6.1; p = .001) in adults and 5.2 times in elderly patients (OR = 5.2; CI 95% = 1.8-16.2; p = .01). Additionally, thorax injury in children increased 3.1 times (OR = 3.1; CI 95% = 1.7-5.7; p = .001). CONCLUSIONS: During the lockdown, injury to oral and maxillofacial regions increased in adult and child victims of domestic violence.

Maxillofacial trauma and its management presenting at a tertiary care hospital in Lahore during Covid-19 pandemic.

Objectives: The objective of this study was to assess the patterns of maxillofacial injuries, aetiology and their management during the pandemic of Covid-19 in a tertiary care hospital in Lahore, Pakistan. METHODS: This is a single center, prospective cross-sectional study. Patients from all age groups who presented at the Emergency room of Jinnah Hospital Lahore and managed by the Oral and Maxillofacial Surgery Department during 1st December 2020 till 31st January 2021 were included. Data were analyzed using IBM SPSS for Windows, Version 20.0. RESULTS: Total 202 patient were analyzed, 161 (79.7%) were male and 41 (20.3%) were females. Male to female ratio was 4:1. About fifty three percent of patients belonged to the age group 15-35 years. The most common cause was road traffic accidents (RTA), followed by fall. Eighty-three (41.1%) had only soft tissue injuries without any bony fracture and 119 (58.9%) had facial bones fractures. Zygomatic bone fracture was most common (53.8%) followed by mandible fracture (31.1%). Sixty-one out of 119 patients with fractures were treated with Open Reduction Internal Fixation (ORIF). Three patients had complete loss of vision because of facial trauma. Only 56 (28%) patients were managed under General Anaesthesia. CONCLUSIONS: During the initial pandemic era, a large majority of patients presenting with maxillofacial injuries were young male adults. The most common cause of maxillofacial trauma was RTAs. Soft tissue injuries were predominant followed by facial bone fractures and zygomatic bone was more frequent among the fracture cases. Covid-19 pandemic increased the difficulties faced in the management of maxillofacial trauma patients.

Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis.

BACKGROUND/AIMS: Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. METHODS: The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. RESULTS: Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). CONCLUSION: The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).

Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme.

The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.

Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis.

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.

The profile of patients with maxillofacial trauma due to interpersonal violence treated in a hospital emergency room.

AIM: This study evaluated records of patients with maxillofacial trauma due to interpersonal violence (IPV) being treated in the emergency room of a level I trauma center hospital in São Paulo, Brazil. MATERIAL AND METHODS: Data of patients with maxillofacial trauma due to IPV recorded between January 2019 and December 2019 were retrospectively examined. Personal data, days on which they experienced IPV, and the type of maxillofacial trauma sustained were extracted and statistically analyzed (p < .050). RESULTS: During the analysis, 1034 patients with maxillofacial trauma were identified; of these patients, 292 (28.2%) who experienced trauma due to IPV were included in this study. There was a mean age of 32.6 years and the most common type of trauma was soft tissue injuries (38.7%). Mandible and nose fractures were more prevalent in males and females, respectively. Our data, when compared with other studies on maxillofacial trauma due to IPV, showed a lower prevalence and male-to-female ratio, and a higher presence of dentoalveolar trauma. Additionally, our data when compared with studies on maxillofacial trauma due to other causes showed lower mean age and male-to-female ratios, and a higher occurrence of nose fractures differing from the predominance of mandibular fractures. CONCLUSION: Oral and maxillofacial surgeons must be able to suspect and identify cases due to IPV among their patients with trauma. With our results, although each case has its individuality, we can suggest that cases of maxillofacial trauma in young, female, and nasal fracture patients may be suspicious for IPV.

A retrospective comparative study of maxillofacial injury patterns caused by electric scooters and bicycles.

BACKGROUND/AIM: The emergence of shared stand-up electric scooters has led to an increase in their usage and, subsequently, an increase in the incidence of maxillofacial trauma. This study aimed to investigate the trauma pattern associated with the use of stand-up electric scooters compared with that related to the use of bicycles, which was a popular mode of personal mobility before the emergence of stand-up electric scooters. MATERIALS AND METHODS: This study investigated the medical records of patients who visited Wonju Christian Hospital for maxillofacial trauma due to the use of stand-up electric scooter and bicycles between November 1, 2017 and October 31, 2022. Maxillofacial trauma was analyzed based on medical records, including those in the evaluation results of teeth, maxillofacial bones, and soft tissues. RESULTS: Crown fractures and tooth avulsions were observed more frequently with the use of stand-up electric scooters than with the use of bicycles. In contrast, crown-root fractures, tooth subluxation, and extrusive luxation were more commonly observed in bicycle riders. Additionally, the proportion of root fractures was similar between the two groups. However, no vertical root fractures were observed in patients who rode bicycles. The maxillofacial bone fracture rates between the two groups were similar, although the fracture patterns were different. CONCLUSION: The number of patients using stand-up electric scooters is increasing, and they are likely to have a worse prognosis compared with those using existing personal mobility devices.

Epidemiology and Pattern of Pediatric Maxillofacial Trauma: A 5-Year Retrospective Study.

PURPOSE: To analyze the epidemiology, pattern, and prevent measurement of pediatric maxillofacial trauma in Xinjiang, China. PATIENTS AND METHODS: Clinical records of patients aged 0 to 18 years with maxillofacial trauma over the 5 years were reviewed. Epidemiological features of data were collected for the cause of injury, age and sex distribution, frequency and type of injury, localization and frequency of soft tissue injuries, facial bone fractures, and presence of associated injuries. Statistical analyses performed included descriptive analysis, χ 2 test, and logistic regression analyses. RESULTS: Among the 450 patients, 333 were male and 117 were female, with a male-to-female ratio of 3.8:1, the mean age was 9.2±5.4 years; 223 cases were soft tissue injuries and 227 cases were maxillofacial fractures. The 16 to 18-year-old group was the highest, with the prevalence of maxillofacial fractures. The most common cause of pediatric maxillofacial trauma was traffic injuries. CONCLUSION: The incidence of maxillofacial trauma in pediatric patients correlates with a number of factors, including age, sex, and etiology of trauma. The 16 to 18-year-old group is the most prevalent group for maxillofacial trauma in pediatric patients, and traffic accidents are the leading cause of maxillofacial trauma in pediatric patients.

Interpersonal Violence and Maxillofacial Injuries: Toward an Active Surveillance Proposal Through the Presentation Profile in Hospital Emergency Services.

To establish a set of variables that define a predictive profile of events of maxillofacial trauma resulting from interpersonal violence, we analyzed sociodemographic variables and clinical characteristics of injuries recorded in three tertiary care hospital centers in Chile. To assess the relation between categories, we applied a multiple correspondence analysis. We identified 567 cases. Two dimensions explained 53.4% of the model. The first dimension was composed of variables related to the severity of the injury: medical-legal prognosis (.574), type of trauma (.511), and the destination of the patient (.332); the second dimension was composed of variables related to the typology of interpersonal violence: type of violence (.398) and sex of the patient (.370). Two profiles were recognized: women, victims of domestic violence, with lesions affecting mainly soft tissues and not requiring hospitalization and men, victims of community violence, with lesions involving fractures associated with greater severity and requiring hospitalization. There are two key dimensions in the diagnosis of maxillofacial trauma resulting from interpersonal violence: severity of the injury and typology of the interpersonal violence. Exploring these predictive profiles can be a useful complement to the current screening tools of violence in clinical practice.

Maxillofacial Injuries in an Eastern Nepal Tertiary Hospital.

BACKGROUND: Maxillofacial injury is a major health problem, and injury patterns vary in different societies. The purpose of the present study was to evaluate the pattern of maxillofacial injuries presenting to BPKIHS. METHODS: Patients with age >15 years presenting with maxillofacial injuries from May, 2019 to April, 2020 were included in this cross-sectional descriptive study. Demographic profile, etiology, delay in presentation, pattern of soft tissue/ bony/ dental injuries, treatment modality were recorded and analyzed using Microsoft excel. RESULTS: Within one year study period 190 patients with age group >15 years presented with facial injuries. There were 164 male (86.32%) and 26 female (13.68 %) patients (M:F=6.3: 1) with mean age of 34.96 years. Road Traffic Accident (RTA) (61.58%) was the most common etiology. Majority of the patients reported to hospital within 2-6 hrs of injury. Other associated injuries was present in 36.32 % of patients with orthopedic injury (60.87%) being common. Soft tissue injuries were seen in 80.53% patients, of which 49.02% were associated with facial fractures. Mandible fractures were seen in 56.19% of hard tissue injuries, of which 40.68% had multiple fractures followed by 28.81% with parasymphysis fracture. Within 37.14% patients with midface fractures, zygoma fracture (33.33%) was the commonest. Intervention was done in 80.95 % patients, with ORIF (72.38 %) being the commonest. Dentoalveolar injuries was seen in 22.63 % patients, of which 48.19% were associated with facial fractures. CONCLUSIONS: Our observations show that motor vehicle accidents were the most frequent cause of maxillofacial injury.

Incidence and features of maxillofacial fractures at Jordanian tertiary hospital before, during and after the COVID-19 period

Background: The purpose of this retrospective cohort study is to investigate the incidence and treatment of maxillofacial fractures before, during, and after the COVID-19 pandemic. Material and methods: This single-center study was conducted at King Abdullah University Hospital (KAUH). The required data was obtained from the electronic clinical records of all patients in whom maxillofacial fractures were confirmed by plain radiography and computed tomography (CT) between January 2019 and December 2021, allowing for a 12-month period before, during and after the COVID-19 pandemic. Results: During the study period, 595 maxillofacial fractures in 311 patients (234 males and 77 females, mean age 27.28 years) were treated. The most frequent affected age was 21-30 years old in the before and after COvid- 19 period (92 patients, 29.58.%), while in during-COVID-19 period it was 11-20 years old (22 patients, 7.07%). There was similarity in male predominance, RTA cause, anatomical site was the mandible, the type anatomical complexity was single, treatment procedure was ORIF in all three periods. Conclusions: The incidence of maxillofacial fractures during the COVID-19 pandemic period was lower compared to the periods before and after the pandemic. Given that most fractures were caused by RTAs, these findings are expected, as movement was restricted during lockdown. (AU)

Comparison of characteristics of kick- and electric-scooter-related dental and maxillofacial injuries: A retrospective study.

BACKGROUND/AIM: Owing to the nearly three-year-long COVID-19 pandemic, small personal transportation devices that allow for greater freedom of movement within the cities have gained attention. Therefore, the number of people using kick or electric scooters has increased. This study aimed to compare the characteristics of kick and electric scooter-related dental and maxillofacial trauma and provide helpful information for preventing scooter accidents, appropriate treatment of patients with scooter-related trauma, and policy establishment. MATERIALS AND METHODS: This retrospective observational study analysed the medical records of 310 patients who visited the emergency room of Ajou University Dental Hospital for kick and electric scooter-related oral and maxillofacial injuries between 1 January 2017 and 31 December 2022. Sex, age, scooter type, time, and mechanism of the accident, helmet use, alcohol consumption, dental and maxillofacial injury types, and treatment were analysed. RESULTS: The average age in the kick-scooter group (5.71 ± 4.25) was lower than that in the electric-scooter group (28.24 ± 10.02) (p < .0001). There were more males in both groups. The helmet usage rates of the two groups were 2.80% and 7.88%, respectively. In the kick-scooter group, periodontal damage was more common than pulp injury, while in the electric-scooter group, pulp injury was more common than periodontal injury. There was no significant difference in soft-tissue damage between the two groups; however, bone fractures occurred significantly more frequently in the electric-scooter group (p < .0001). CONCLUSIONS: Electric scooters cause more crown and bone fractures than kick scooters and require more active treatment of dental and maxillofacial injuries. Riders should use protective equipment to prevent dental and maxillofacial injury. Although there are regulations related to scooters, the effectiveness of both kick- and electric-scooter related laws needs to be evaluated.

Maxillofacial fractures in Pondicherry, India: An eight-year single centre retrospective study.

Background: The purpose of the present study was to analyze the etiology, incidence, pattern, and treatment modalities of patients with maxillofacial fractures treated at the Department of Dentistry of a medical college in Pondicherry during the period between June 2011 and June 2019. Materials and Methods: A retrospective epidemiological study of 277 patients treated for maxillofacial fractures between June 2011 and June 2019 was performed. Data regarding age, gender, etiology, site of the fracture, time of injury, presence of associated injuries, treatment modalities, and complications were recorded. Results: A total of 491 maxillofacial fractures were seen in 277 patients. These were 261 males (94.2%) and 16 females (5.8%) with a male to female ratio of 16.3:1. Most of the patients 79.8% were in the age group of 11 to 40 years. Most common cause of injury was Road Traffic Collisions (RTCs; 62.1%), followed by fall (20.2%), assault (14.4%) and others (3.3%). Fractures of the mandible (52.3%) and zygomatic complex (18.9%) were the most common maxillofacial fractures reported in our study. 196 patients sustained associated injuries with a prevalence of soft tissue injury (61.2%). Majority of fractures were treated with open reduction and internal fixation (ORIF; 71.9%) of patients followed by closed reduction (17.7%) and observation only (10.4%). Postoperative complications were presented in 16.8% of the patients in the study. Conclusion: RTC is the commonest cause of maxillofacial injury with a male predominance in our study. Mandibular and zygomatic complex fractures were the most common. ORIF remains the preferred method of treatment.s.

Factors predicting oral and maxillofacial fractures after falling and factors predicting the duration of treatment.

BACKGROUND/AIM: The first objective of this study was to identify predictive factors for oral and maxillofacial fractures at the initial response to the patient. The second objective was to determine the factors influencing the incidence of treatment duration of more than 1 month using the information shown in the medical record. MATERIALS AND METHODS: Hospital records from 2011 to 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries by falling or falling from a height. Patterns and types of oral and maxillofacial injury, injury severity, and background of the injury were collected from the hospital records. The variables independently associated with a treatment duration of more than 1 month were determined by logistic regression analysis. RESULTS: In total, 282 patients (150 men, 132 women; median age, 17.5 years) were selected for analysis. Maxillofacial fractures were observed in 20.9% of patients (59/282); among these, mandibular fractures were the most common (47/59). Logistic regression analysis showed that age (odds ratio [OR], 1.026), nighttime occurrence (OR, 2.192), and upper face injury (OR, 20.704) were independent predictive factors for having a maxillofacial fracture. Additionally, the number of injured teeth (OR, 1.515) and the use of intermaxillary fixation (OR, 16.091) were independent predictors of treatment duration of more than 1 month. CONCLUSIONS: These results may be useful in the initial management of maxillofacial injuries in terms of better-informing patients injured by falling their expected treatment duration and managing the psychological impacts of a long treatment duration.

Pattern and management of maxillofacial fractures in Jordanian children and adolescents

Background: The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. Material and methods: A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. Results: Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. Conclusions: Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality. (AU)

A Review of Medical Evacuations Related to Dental Emergencies and Oral-Maxillofacial Injuries.

A literature review was performed to determine the frequency of medical evacuations (MEDEVAC) that are required for dental emergencies (DE) and oral-maxillofacial (OMF) injuries. Fourteen studies were reviewed altogether - eight which quantified evacuation of DEs or OMF injuries in military personnel (from 1982-2013) and six studies that discussed medical evacuation of DEs occurring in civilians working in offshore oil and gas rigs and wilderness expeditions (from 1976-2015). Among military personnel, DE/OMF issues were frequently among one of the top categories of medical evacuations, ranging from 2-16% of all evacuations. Among oil and gas industry workers, 5.3-14.6% of evacuations were dental-related, while one study of wilderness expeditions found that DEs ranked as the third most frequent type of injury that required evacuation. Previous studies have shown that dental and OMF problems often account for one of most frequently cited reasons for evacuation. However, due to the limited study base of DE/OMF medical evacuations, further research is needed to determine their impact on the cost of health care delivery.

Management Strategies for Geriatric Maxillofacial Fractures: An Anthropometric and Clinical Study in Taiwan.

BACKGROUND: Geriatric maxillofacial trauma has become an increasingly pressing clinical issue in Taiwan because of increased life expectancy. AIM AND OBJECTIVES: The purposes of this study were to investigate the anthropometric changes and the posttrauma outcomes in the aging population and to optimize the management strategies for geriatric facial fractures. MATERIALS AND METHODS: From 2015 to 2020, a total of 30 patients 65 years or older were identified to have suffered from maxillofacial fractures and presented at the emergency department of the Chang Gung Memorial Hospital (CGMH). These patients were categorized into group III, representing the elderly group. Two other groups (group I, age 18-40 years; group II, age 41-64 years) of patients were categorized based on their age. After applying propensity score matching to reduce bias caused by a large case number difference, patient demographics, anthropometric data, and management methods were compared and analyzed. RESULTS: Among 30 patients 65 years or older who met the inclusion criteria, the mean age of the matched group III was 77.31 ± 14.87 years, and the mean number of retained teeth was 11.77 (range, 3-20 teeth). The elderly patients had a significantly lower number of retained teeth (group I vs group II vs group III, 27.3 vs 25.23 vs 11.77; P < 0.001). Anthropometric data showed that facial bone structure degenerated significantly with advancing age. Outcome analysis demonstrated that falls accounted for 43.3% of injury mechanisms in the elderly group, followed by motorcycle accidents (30%) and car accidents (23.3%). Nineteen elderly patients (63%) received nonsurgical management. On the other hand, 86.7% of cases in the other 2 age groups underwent surgery. The average numbers of total hospital and intensive care unit stays in group III patients were 16.9 (range, 3-49 days) and 4.57 (range, 0-47 days), which was significantly longer than the other 2 age groups. CONCLUSIONS: Our results suggested that not only surgery is feasible for elderly patients with facial fractures, but an acceptable result is often obtainable. However, an eventful course, including extended hospital/intensive care unit stays and an increased risk of associated injuries and complications, may be expected.

A meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies among children and adolescents.

AIMS: Children and adolescents who are affected by trauma may have complications that are more serious and dangerous. Herein, a meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies according to the geographic regions of the world among children and adolescents was conducted. MATERIALS AND METHODS: A comprehensive search was performed in four databases of PubMed/MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2006 until July 7, 2021. To evaluate the quality of included articles, an adapted version of the Newcastle-Ottawa scale was used. The prevalence of maxillofacial trauma was estimated by event rates and 95% confidence intervals in relation to etiology and geographic region of study population. RESULTS: Through search in the databases and the electronic sources, 3071 records were identified, and 58 studies were eligible for inclusion in the meta-analysis. A total of 264,433 maxillofacial trauma cases were reported by all included studies. Globally, the overall prevalence of maxillofacial trauma was highest due to Road Traffic Crashes (RTC) (33.8%) followed by falls (20.7%), violence (9.9%), and sports (8.1%) in children/adolescents. The highest prevalence of maxillofacial trauma were observed in African population (48.3%) while trauma due to falls was most prevalent in Asian population (44.1%). Maxillofacial trauma due to violence (27.6%) and sports (13.3%) were highest in North Americans. CONCLUSION: The findings demonstrate that RTC was the most prevalent etiology of maxillofacial trauma in the world. The prevalent causes of maxillofacial trauma differed between the regions of study population.

Oral and Maxillofacial Injuries Associated With E-Cigarette Explosions: A Systematic Review and Management Guidelines Proposal.

PURPOSE: E-cigarettes have become increasingly popular devices used to consume nicotine in recent years. There is a growing body of evidence regarding the risk of spontaneous explosion of these devices causing burn and projectile injuries. The primary purpose of this review was to summarize all injuries to the oral and maxillofacial region secondary to explosion of e-cigarettes. The secondary purpose was to propose an initial management algorithm for such injuries based on the findings in the literature. This review also aims to test the hypothesis that e-cigarette explosive injuries to the oral region were associated with an increased risk of intubation and surgery and examine whether any other injury pattern was associated with an increased risk of intubation or surgery. METHODS: A cohort study based on identifying cases in the literature was conducted to summarize injuries to the oral and maxillofacial region and examine the associations between injury types and location and management. A literature search of the major biomedical databases was conducted in September 2022 using terms such as e-cigarette, explosion, blast, trauma, and burn, among others, which yielded 922 studies. Nonclinical studies, review articles, and studies without injuries to the facial region were excluded. Study subjects were recorded for demographics, device characteristics, injury mechanism, injury location, management, and complications. Chi-squared analysis was used to determine if the predictor variables of type of injury (burn or projectile) and its associated location (ocular, facial, or intraoral for burns and facial thirds for projectile) were associated with the outcomes of intubation and surgical management. The collected data were then used as a guide to propose an initial management algorithm for these injuries. RESULTS: Twenty eight studies, including 20 case reports and 8 case series met the inclusion criteria. A total of 32 explosions of e-cigarettes to 32 patients caused 105 recorded injuries to the facial region. Projectile injuries made up 73.3% (n = 77) of all facial injuries, while burn injuries made up of 26.7% (n = 28). There were 14 (43.8%) patients who suffered both projectile and burn injuries. Burn injuries mostly involved the face (64.3%, n = 18), oral cavity (25%, n = 7), and eye (10.7%, n = 7). The majority (81.8%, n = 63) of projectile injuries occurred in the lower facial third. There were 20 (62.5%) patients who suffered a bone or tooth fracture. Management of injuries involved surgery in 62.5% (n = 20) of patients, which included open reduction and internal fixation of fractures, dental extraction, bone and skin grafts, and ocular surgery. A complication rate of 44.4% (n = 8) was observed across studies that reported on follow-up. There was no statistically significant association between explosive injury to the oral region and intubation or surgical management. There was also no other statistically significant association between any other injury type and location with intubation or surgical management. CONCLUSIONS: E-cigarettes are at risk for spontaneous combustion that can cause serious oral and maxillofacial injuries, particularly to the lower facial third and commonly requiring surgical management. Safety of these devices should be improved through increased user education and regulation.

Concomitant Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An 11 Year Review of the National Trauma Data Bank.

PURPOSE: Craniofacial trauma with concomitant cervical fractures (CCFs) is responsible for significant morbidity and mortality in the pediatric population. We aim to characterize its incidence, injury patterns, outcomes, and risk factors, along with identifying any association between mandible fractures and cervical injuries via the National Trauma Databank. METHODS: A retrospective cohort study was performed using National Trauma Databank records between 2007 and 2017 to identify patients equal or under the age of 18 years hospitalized for maxillofacial trauma and with recorded cervical injury. Variables of interest include age, gender, race/ethnicity, trauma type (blunt vs penetrating), Injury Severity Score, area involved, mechanism of injury, comorbid conditions, inpatient complications, and discharge disposition. Retrospective cohorts were separated by CCF status. Univariate, bivariate, and multivariable regression analysis was utilized, with P-value <.05 considered statistically significant. RESULTS: A total of 32,952 patients were included in the study, with the majority being White (60.8%), male (68.2%), and between the ages of 13 and 18 years (65%). Of these, 8.2% experienced CCF. Most common mechanisms of injury were motor vehicle trauma (32.6%), interpersonal violence (18.8%), and falls (13.5%). Univariate analysis revealed patients with CCF were significantly older (15.2 vs 12.9; P < .001), more likely to be motor vehicle occupants (46.6 vs 31.9%; P < .001), and suffer polyfacial fractures (62.6 vs 60.7%; P < .001). Longer length of stay (9.4 vs 3.6 days; P < .001) and significantly higher inpatient complications such as deep vein thrombosis, pulmonary embolism, unplanned intubation, severe sepsis, pressure ulcer, ventilator-associated pneumonia, and unplanned return to operating room were observed in the CCF cohort. Female gender (1.5 [1.37 to 1.64; 95% confidence interval {CI}] P < .001) and higher Injury Severity Score (1.12 [1.11 to 1.11; 95% CI] P < .001) were associated with significantly higher odds on multivariable analysis. The presence of a mandible fracture was not associated with increased CCF on multivariate analysis (1.06 [0.92 to 1.22; 95% CI] P = .36). CONCLUSIONS: There are statistically significant differences in demographics, outcomes, and injury patterns in maxillofacial patients with CCF that may help guide treatment. No association between mandible fractures and cervical trauma was identified.