Etiology, Incidence and Patterns of Mid-Face Fractures and Associated Ocular Injuries

Abstract

A prospective study on mid-face fractures was carried out in the Department of Oral and Maxillofacial Surgery at College of Dentistry, Indore, from August 2007 to September 2009 to analyze etiology, incidence and patterns of midface fractures and associated ocular injuries. Two hundred patients were included in this study, amongst those who reported to the Department of OMFS, College of Dentistry, Indore. After confirmed diagnosis of mid face fracture all the patients were stratified according to age, sex, cause of the accident, influence of alcohol, location, type of fractures and associated ocular injuries. The study included 200 patients with a mean age of 29.6 years. The most frequently injured patients belonged to the 21-30 year-old age group. The male predilection was 76 %. Road traffic accident was the most common causative factor (64 %), followed by assault (21 %), cases of fall (9.5 %) and other causes (5.5 %). The most common fracture in this study was found to be zygomatic complex fractures (62.5 %) (more in the age group of 21-30 years). This was followed by Lefort II fractures (23 %), multiple fractures (10 %) and Lefort I fractures (6 %), Lefort III fractures (4.5 %) and Naso-ethmoidal fractures (4 %) in descending order. 84.5 % subjects were having ocular involvement. Subconjunctival hemorrhage was present mostly in 83.5 % followed by remaining as corneal injury 15 %, reduced acuity 11.5 %, diplopia 10.5 %, enophthalmos 8.5 %, telecanthus 5 %, hyphema 3.5 %, blindness 3 % and proptosis 0.5 %. Zygomatic complex fractures were the most frequent type of injury that was complicated by blindness or a serious eye injury (61 %). Collection of data regarding the epidemiology of maxillofacial fractures is important because it may assist healthcare providers to provide necessary information for the development and evaluation of preventive measures. Ocular injuries should have an early ophthalmological examination at the time of trauma to detect any kind of ocular dysfunction.

Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study

“…Hyphema or bleeding in the anterior chamber is mostly caused due to tearing of blood vessels at the root of the iris. 1,11,15 In this study, hyphema/anterior chamber injury was present in 12.3%, which is slightly higher than in other studies.…”

“…This was slightly lower than that reported by Septa et al (3.16:1), Cheema, and others. 1,3 This shows that females are more involved in social activities and frequently using MTW for the mode of transportation in our population. Previous studies have reported that the zygomatic complex fracture was the most common type in all facial middle third injuries.…”

“…Vision loss or blindness is an uncommon complication, it is reported between 0.3 and 3.5% by many authors. 1,6,11,12 in their studies. Three of our patients (1.5%) had permanent vision loss because of ruptured globe injury due to trauma.…”

“…Young adult males in the age group of 20 to 40 are the most common users of MTWs and are commonly involved in road traffic accidents (RTAs). [1][2][3] Road traffic accidents are the major cause of maxillofacial injuries. Maxillofacial injuries mainly involve the middle third of the face.…”

Maxillofacial Fractures; Assessment of Concomitant Injuries

“…19,20,21 The etiology of maxillofacial & concomitant injuries in our study results clearly indicated RTA was the widespread causative factor followed by assaults, which were similar with the studies conducted in different parts of world. 15,19,22,23 Maxillofacial injuries are barely fatal; however these injuries certainly cause physical/ psychological stress to the patient. 16 Maxillofacial injuries might comprise upper third, middle third, and/or lower third of the face, inclusive or exclusive of soft tissue injury & most of the times dentition possibly will also have injuries i.e.…”