ISPUB.COM
The Internet Journal of Third World Medicine
Volume 10 Number 1
Maxillofacial Trauma: Prevalence in the San Vicente de
Paúl Regional University Hospital, San Francisco de
Macorís, Dominican Republic.
R Hernández, R Hernández, A Hernández, Z Gil
Citation
R Hernández, R Hernández, A Hernández, Z Gil. Maxillofacial Trauma: Prevalence in the San Vicente de Paúl Regional
University Hospital, San Francisco de Macorís, Dominican Republic.. The Internet Journal of Third World Medicine. 2012
Volume 10 Number 1.
Abstract
Worldwide maxillofacial injuries have become a social problem, since there has been an alarming increase of this type of injury.
In the Northeast region of the Dominican Republic the facial trauma constitutes a significant proportion of all trauma, although
epidemiological studies in the country are few. A retrospective study was undertaken to assess causes of maxillofacial trauma in
the San Vicente de Paúl Regional University Hospital in the town of San Francisco de Macorís, Duarte State, Dominican
Republic. Between July 2002 and July 2011, 786 cases of maxillofacial fractures were seen at the Oral and Maxillofacial
Surgery Unit of this Hospital. Most fractures occurred in adults with ages ranging from 21 to 30 years (30.2%). Men (58.5%)
were more affected than women (41.5%) and most patients treated were from the locality of San Francisco de Macorís (34.2%).
Traffic accidents/motorcycles (39.7%) were the major cause of trauma, followed by automobile accidents (18.7%) and physical
violence (16.4%). Hard tissue injuries (63.5%) were more common. The mandible (22.1%) was found to be the most commonly
fractured bone in the facial skeleton, followed by the zygomatic complex (12.7%). Wounds or lacerations (24.0%), edema (4.6%)
and hematoma (4.6%) were the most common types of soft injuries.
INTRODUCTION
A trauma is defined as tissue damage caused by mechanical
agents that produce sequels such as wounds or lacerations,
edema, ecchymosis and fractures1. This has become a huge
health problem, being regarded as the third leading cause of
death worldwide, surpassed only by cardiovascular disease
and cancer2. Being the most exposed part of the body, the
face is particularly vulnerable to such injuries, 20–60% of all
those involved in automobile accidents having some level of
3, 4
facial fractures .
Maxillofacial traumas are injuries that affect facial structure
and have vital consequences, functional or aesthetic,
producing emotional distress, disability or long-term
deformity. The severity of this trauma lies in the
commitment of anatomical structures such as nasal cavity,
paranasal sinuses, orbits and other adjacent as brain and
cervical spine5.
The number of patients with maxillofacial injuries that are
received in the various emergency services from different
health facilities includes a significant percentage, and
growing, of all treated patients1. Surveys of facial injuries
have shown that the etiology varies from one country to
another and even within the same country depending on the
prevailing socioeconomic, cultural and environmental
factors6,7. Earlier studies from Europe and America showed
that road traffic crashes were the most frequent cause of
facial injuries8,9. However, more recent studies have shown
that physical violence is now the most common cause of
10-11
maxillofacial injuries in developed countries , whereas
traffic accidents remain the most frequent cause in several
developing countries12-13.
Considering that there were no official statistics on
maxillofacial trauma in the Northeast Cibao region of the
Dominican Republic, was decided to make this investigation
in order to determine the prevalence of maxillofacial trauma
that arise. Hopefully, the information obtained will help to
improve knowledge and prevention of maxillofacial injuries,
in this community in particularly. The Northeast Region
includes the provinces of: 1- Duarte with the municipalities
of San Francisco de Macorís, Villa Rivas, Castillo, Pimentel,
Arenoso, Las Guáranas and Hostos. 2- María Trinidad
Sánchez with the municipalities: Nagua, Cabrera, El Factor
1 of 6
Maxillofacial Trauma: Prevalence in the San Vicente de Paúl Regional University Hospital, San Francisco
de Macorís, Dominican Republic.
and Río San Juan. 3- Sámana: Santa Bárbara de Samaná,
Sánchez and Las Terrenas. 3- Hermanas Mirabal: Salcedo,
Tenares and Villa Tapia.
This research was conducted at the San Vicente de Paúl
Regional University Hospital, in the municipality of San
Francisco de Macorís, Duarte Province, Dominican
Republic. This hospital also receives patients from other
nearby locations and municipalities outside the region such
as La Vega and Cotuí.
MATERIALS AND METHODS
All patients presenting facial trauma were seen in the
maxillofacial unit of San Vicente de Paúl Hospital from
November 2002 to November 2011, with a cross-sectional
retrospective study conducted in December 2011. The
information was obtained through the departments of
archives and statistics of this hospital. A protocol was
prepared to identify the following features: gender
predilection, peak age of incidence, municipality with the
highest frequency of patients, etiology of injury, as well as
type and site of the trauma.
The etiology was classified as: traffic accidents (cars,
motorcycles and pedestrian), physical violence, accidental
falls, sports accidents, weapon injuries (knife and fire gun)
and other causes.
Figure 1
Table 1.- Distribution of patients by gender.
Figure 2
Table 2.- Distribution of patients by age and gender.
The great majority of trauma cases in the population under
study were from San Francisco de Macorís with 34.2%
(table 4), followed by Nagua (11.6%) and Castillo (7%). La
Vega provided the least amount of cases with only 0.4%.
Figure 3
Table 3. - Distribution of patients by municipalities of
origin.
The investigation was conducted using data contained in
medical records according to the International Classification
of Diseases and Health Related Problems (ICD-10), codes
which referred to maxillofacial trauma associated with
terminations to the location of the trauma and causes were
handled. Only medical records with complete information
were included. Seven hundred and eighty six (786)
maxillofacial trauma patients participated in the research.
Data was analyzed and tables were made using Microsoft
Office Excel 2007.
RESULTS
Seven hundred and eighty-six patients were seen and treated
in the maxillofacial unit at the Hospital of San Vicente de
Paúl from November 2002 to November 2011. The majority
of facial trauma patients were male with a total of 58.5%
(female: 41.5%; Table 1). The peak age of incidence in men
and women involved with maxillofacial trauma was 21–30
years (30.2%; table 2) followed by 31–40 years (21.9%).
2 of 6
Road traffic accidents (table 3) were the most frequent
aetiological factor, mainly motorcycle accidents (40.7% of
all males; 38% of all females) with 39.7% of all etiologies
followed by car accidents (18.6% males; 18.8% females)
with a total of 18.7%. The least common were falls (1.2%
Maxillofacial Trauma: Prevalence in the San Vicente de Paúl Regional University Hospital, San Francisco
de Macorís, Dominican Republic.
male, 1.7% female; total 1.4%).
Figure 5
Table 5. - Distributions of maxillofacial injuries.
Figure 4
Table 4. - Distribution of patients by aetiology and gender.
Regarding the type of injury (table 5), it was found that the
great majority of cases were hard tissue injuries (63.5%).
Mandibular fractures were the most common (22.1%),
followed by zygomatic-orbital complex (12.7%), combined
fractures (11.7%), dentoalveolar (5.1%), nasal and middle
third fractures (4.3% each), panfacial (1.8%), and nasoorbital-ethmoid (1.5%). Soft tissue injuries (36.4%) in the
form of a wound or laceration (24.0%), followed by edema
and hematoma (4.6% each), and ecchymosis (1.8%) were the
most common types of these kind of injury.
DISCUSSION
The human face constitutes the first contact point in several
human interactions, thus injuries and/or mutilation of the
facial structures may have a disastrous influence on the
affected person14.
Injuries to the craniomaxillofacial area affect a significant
number of trauma patients, and consequences of trauma to
this region can include any combination of dental, bone, or
soft tissue injury15. The knowledge and the accuracy of the
information on maxillofacial trauma have a significant
involvement in treatment planning of future services, and
design of preventive measures.
The sex distribution in this investigation is consistent with
16,17,18,19, 20, 21
others studies
, with a higher frequency of
Maxillofacial trauma in males than females. But unlike these
studies, the range of difference found between these two
genders (58.5% male, 41.5% female) is not large, which is
3 of 6
Maxillofacial Trauma: Prevalence in the San Vicente de Paúl Regional University Hospital, San Francisco
de Macorís, Dominican Republic.
explained by the rising tide of violence in the female
community in the country.
Facial trauma is most common in the third decade,
consistent with much of the international and worldwide
literature. The age distribution in this study showed that the
most common age group involved was 21 to 30 years of age,
in agreement with previous studies21, 22, 23, 15. This can be
explained by the increased physical activity, number of
19
fights and self mobility of young adults (20s) . This finding
differs slightly in the age range with the investigation of Lin
et al (2007), which positioned the group of 19 to 28 years as
the most frequently affected. While Klenk et al (2003) in
their study indicated that the most frequently injured patients
belonged to the 16 to 20 years of age, in contrast with the
results of this research.
San Francisco de Macorís had the highest number of patients
treated for facial trauma within the population studied,
followed by Nagua. La Vega, meanwhile, had the lowest
number of patients, which may be because this town has its
own trauma hospital, Juan Bosch, and only a few patients for
personal reasons, choose the hospital of San Vicente de Paul.
The present study supports the findings of early studies in
3, 8, 9, 12, 13, 14, 17, 21, 22
developing countries
of traffic accidents
been the most common cause of maxillofacial injuries
worldwide, with an impressive and disturbing 63.1 percent
of all etiological factors. But is in disagreement with other
reports7, 10, 11, 25 from developed countries where physical
violence has replaced traffic accidents as the major cause of
maxillofacial injuries.
The reductions in traffic accidents in developed countries are
largely attributed to a wide range of road safety measures
such as seat belt use, traffic calming measures and traffic
law enforcement. Therefore, there is an urgent need to get
down to what the developed nations have done to
reduce/prevent road traffic crashes13.
Physical violence was the second most common cause of
maxillofacial injuries in the population studied in the
Northeast Region. Perhaps, the poor socioeconomic
conditions of the country and area have led to stress and
propensity to different ways of crime like robbery; and an
excessive drinking can explain the increasing aggressionrelated maxillofacial injuries.
Hard tissue injuries were more common than the soft ones,
agreeing with the investigation of Laski et al (2004). This
4 of 6
finding disagrees with similar studies in which soft tissue
injuries were more common27.Of soft tissue injuries,
lacerations or wounds were the most frequent consistent with
the study of Gassner et al (2003), followed by edema and
hematoma with the same amount of cases and ultimately,
ecchymosis.
The mandible was the most frequent fractured bone in this
3, 4, 5, 11, 16, 17, 19,
study, agreeing with most of the similar studies
20, 21, 23
. Malar zygomatic complex fractures followed
mandible fractures. Maxilla fractures28 and malar zygomatic
complex/arch were reported by other studies as the most
frequently involved area13.
CONCLUSIONS
References
1. Núñez Gil, Z: Guía de la Emergencia en Cirugía BucoMáxilofacial. Impresora del Nordeste S. A.; 2004. Pág. 18
2. Shorr RM, Crittenden M, Indeck M, et al.: Blunt thoracic
trauma: analysis of 515 patients. Ann Surg 1987; 206:200-0.
3. Kihlbert JK: Head injury in automobile accidents.
Automobile Injury Research Report 1965; No VJ-1823-R17.
4. Nahum AM, Siegel AW, Brooks S: The reduction of
collision injuries. Past, present and future. In Proc 14th
STAPP Car Conference New York: Society of Automobile
Engineers; 1970:1-43.
5. Eggensperger NM, Danz J, Heinz Z, Iizuka T.
Occupational maxillofacial fractures: A 3-year survey in
Central Switzerland. J Oral Maxillofacial Surg. 2006;
64:270-276.
6. Olasoji HO, Tahir A, Arotiba GT: Changing picture of
facial fractures in northern Nigeria. Br J Oral Maxillofac
Surg 2002; 40:140-143.
7. Magennis P, Shepherd J, Hutchison I, Brown A: Trends in
facial injuries: increasing violence more than compensate for
decreasing road trauma. BMJ 1998; 316:325-332.
8. Van Hoof RF, Mrérlex CA, Stekelenberg EC: The
different pattens of fractures of the facial skeleton in four
european countries. Int J Oral Surg 1977; 6:3-11.
9. Afzeilus LE, Rosen C: Facial fractures: A review of 368
cases. Int J Oral Surg 1980; 9:25-33.
10. Brown RD, Cowpe JG: Patterns of maxillofacial trauma
in two different cultures. J R Coll Surg Edinb 1985:
30:299-302.
11. Laski R, Ziccardi VB, Broder HL, Janal M: Facial
trauma: a recurrent disease? The potential role of disease
prevention. J Oral Maxillofac Surg 2004; 62:685-688.
12. Ansari MH: Maxillofacial fractures in Hamedan
province, Iran: a retrospective study (1987–2001). J
Craniomaxillofac Surg 2004; 32:28-34.
13. Fasola AO, Obiechina AE, Arotiba JT: An audit of
midfacial fractures in Ibadan, Nigeria. Afr J Med Med Sci
2001; 30:183-186.
14. Zargar M, Khaji A, Karbakhsh M, Zarei MR:
Epidemiology study of facial injuries during a 13 month of
trauma registry in Tehran. Indian J Med Sci. 2004;
58:109-14.
15. Al-Khateeb T, Abdullah F: Craniomaxillofacial injuries
in the United Arab Emirates: a retrospective study. J Oral
Maxillofac Surg. 2007; 65: 1094-101.
16. Singh JK, Lateef M, Khan MA, Khan T: Clinical study
Maxillofacial Trauma: Prevalence in the San Vicente de Paúl Regional University Hospital, San Francisco
de Macorís, Dominican Republic.
of maxillofacial trauma in Kashmir. Indian J Otolaryngol
Head Neck Surg. 2005; 57:24-7.
17. Khan SU, Khan M, Khan AA, Murtaza B, Maqsood A,
Ibrahim W, et al.: Etiology and pattern of maxillofacial
injuries in the armed forces of Pakistan. J Coll Physicians
Surg Pak. 2007; 7: 94-7.
18. Malara P, Malara B, Drugacz J: Characteristics of
maxillofacial injuries resulting from road traffic accidents - a
5 year review of the case records from Department of
Maxillofacial Surgery in Katowice, Poland. Head Face Med.
2006; 2: 27.
19. Chrcanovic BR, Freire-Maia B, Souza LN, Araújo VO,
Abreu MH: Facial fractures: a 1-year retrospective study in a
hospital in Belo Horizonte. Braz Oral Res. 2004; 18:322-8.
20. Brasileiro BF, Passeri LA. Epidemiological analysis of
maxillofacial fractures in Brazil: a 5-year prospective study:
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2006;102: 28-34.
21. Klenk G, Kovacs A: Etiology and patterns of facial
fractures in the United Arab Emirates. J Craniofac Surg.
5 of 6
2003; 14: 78-84.
22. Lin S, Levin L, Goldman S, Peled M: Dento-alveolar
and maxillofacial injuries - a retrospective study from a level
1 trauma center in Israel. Dent Traumatol. 2007; 23:15523. Akama MK, Chindia ML, Macigo FG, Guthua SW:
Pattern of maxillofacial and associated injuries in road traffic
accidents. East Afr Med J. 2007;84:287-95.
24. King RE, Scianna JM, Petruzzelli GJ: Mandible fracture
patterns: a suburban trauma center experience. Am J
Otolaryngol 2004;25:301-307.
25. Gassner R, Tuli T, Häch O, Rudisch A., Ulmer H:
Cranio-maxillofacial trauma: a 10 year review of 9543 cases
with 21 067 injuries. Elseiver Journal 2003; Vol 31, 1:51–61
26. Zerfowski M, Bremerich A: Facial trauma in children
and adolescents. Clinical Oral Investigations 1998; Vol 2, 3:
120-124.
27. Shahim FN, Cameron P, McNeil JJ. Maxillofacial
trauma in major trauma patients. Aust Dent J.
2006;51:225-30.
Maxillofacial Trauma: Prevalence in the San Vicente de Paúl Regional University Hospital, San Francisco
de Macorís, Dominican Republic.
Author Information
Rosa Arelis Hernández, DMD
Católica Nordestana University
Rosangel Hernández, MD
Católica Nordestana University
Angel Hernández, MD
Católica Nordestana University
Zoilo Núñez Gil, PhD
Associate Professor, Department of Oral and Maxillofacial Surgery, Católica Nordestana University
6 of 6