An assessment of maxillofacial fractures: A two-year retrospective study.

Sir,

The epidemiology of facial fractures varies in type, severity, and cause depending on the population studied.[1]

Analysis of the epidemiology and treatment of facial fractures reveals the incidence, gender and age predilection, etiology, presentation of the patient from date of trauma, date of surgery, followed by the date of discharge. We also get an insight in the distribution of the sites of fractures as well as any complications that might arise due to the trauma itself or as a result of surgery.

In our study the incidence of facial fractures was found to be more in males during the third decade of life. The reason for this result could be that this age group is usually involved in availability of fast vehicles, careless driving and not following traffic discipline. Higher incidence of trauma in males could be because of their higher involvement in interpersonal violence, road traffic accidents and sports.

According to our study, mandible was the most commonly isolated fractured bone with the incidence of 58%. The condyle (25.5%) and parasymphyseal (45.5%) were the anatomical sites most fractured. The zygoma was the second most frequent bone fractured (12%). Isolated injuries (82 %) of the facial bone were found to be in majority than the combined injuries (18%).Open reduction and internal fixation was indicated for most of the patients.

Road traffic accidents (RTA) are the most common etiologic factor for maxillofacial fractures in developing countries like India.In this part of the country wearing of helmet is mandatory but lack of compliance by the public and weak legislation leads to maxillofacial and head injuries frequently reported. Nakamura and Gross,[2] found RTA as etiological factor for trauma only in 17% patients,which shows that in some developed countries RTA is not the most common cause for facial fracture. Tanaka et al.,[3] found that the reason for the different rates of trauma due to RTA in developed countries could be because of use of seatbelts, construction of roads and subways , more effective traffic discipline.

Our series revealed the average period between time of trauma and hospital consultation was four days and the average period between first consultation and surgery was nine days.

Various reasons for surgical delay had been found out. Delay in hospital consultation of the patient (24%) and the problem with the medical fitness (8%) of the patient is found to be the major reasons for the delay in surgical management. Other reasons are any other associated injuries (6%), some patient's problem (10%) and delay due to hospital problems (4%). It can be said that the relative poverty amongst the people who visited our rural-based hospital was the primary cause of the delay in reporting to hospital and seeking treatment. A logistical problem such as availability of anesthetic back up in a multidisciplinary hospital was also a factor in delay in providing timely care. According to Marciani,[4] at least a third of the patients do not follow the prescribed medical regimen.

Post-operative complications were found in 22% of patients. We were unable to find any significant difference in infection observed in five of our cases whether they reported to us early or late. According to study by Philip et al.,[5] in 2000, surgical delay of a compound fracture was found to be one of the important reasons for developing post-operative infection.

This study supports the view that the incidence and etiology of facial fractures in developing countries varies from developed countries. It is important to explore various reasons for delay in surgical management of patient so that timely and proper care can be instituted to the patient.