Maxillofacial fractures: A retrospective study

Introduction: Aim of the retrospective study is to determine the type and frequency of the maxillofacial fractures and to assess their sex, age, site distribution, and treatment accordingly. Materials and Methods: Study was conducted based on year-wise data collected from 2015 to 2018, with 280 cases recorded. Results: Study group consists of total 280 patients, out of which 28(10%) were females and rest 252(90%) were males. The most common maxillofacial fractures are mandibular fractures in which body of the mandible have the highest occurrence rate and among 280 cases, 187(66.78%) were treated by open reduction and fixation. Conclusion: Results of the study shows the majority of injuries were in males and Mandible was the most commonly fractured bone with the body of the mandible region as the most frequent site. Open reduction and fixation remain the choice of treatment.


Introduction
Fracture is a break in bone or cartilage. Although fracture is a result of trauma but can also be as a result of an acquired disease of bone or abnormal formation of bone in a congenital disease. Maxillofacial injury simply means trauma to the middle third of facial skeleton and/or mandible including soft-tissue injury, the maxillofacial region is the most exposed part of the body and is prone to injury. 1 The pattern and etiology of maxillofacial trauma differ from one country to another and the prevailing socioeconomic and cultural factors. 2 Periodic evaluation of patients helps us understand the demographics and epidemiology to increase awareness and to prevent such fractures. 3 The aim of this study was to give a retrospective analysis of a number of maxillofacial trauma cases reported to our institute.

Materials and Methods
Retrospective study was conducted based on year-wise data on patients sustaining maxillofacial fractures during 2015 to 2018, and the information was collected from our hospital records, under categories of age, sex and site with its frequency, which were registered in the department of oral medicine and radiology at Malla Reddy institute of dental sciences in Telangana.  Table 2 shows further division of mandibular fractures. Where mandibular fractures are seen mostly in body of the mandible with 40 cases (23.95%), followed by fractures in neck of the condyle (21.55%) and dentoalveolar fractures (21.55%). Later on the track comes the subcondylar fractures (11.97%), parasymphysis fractures (11.37%), angle of the mandible fractures (5.38%), head of the condyle fractures (2.99%) and fracture of symphysis region with 2 cases (1.19%). Gender distribution of the maxillofacial fractures are represented in table 3 and table 4. according to this study most of the maxillofacial fractures are seen in males rather than females. The most common fractures of maxillofacial region are mandibular fractures which are common in males with 148 cases (88.62%), and least number of cases are recorded under orbital fracture with 9 cases which are male patients.  Regarding treatment modalities as shown in Table 6. 66.78% of fractures cases are treated by open reduction and fixation process. Whereas 23.92% of cases where treated by closed reduction process and the rest of the cases where kept under observation i.e. 9.28% for healing process.

Discussion
The present study was conducted to retrospectively assess the pattern of maxillofacial fractures in the department of oral medicine and radiology at Malla Reddy institute of dental sciences in Telangana.
Having taken site distribution into consideration, mandibular fractures are more common. Of which, fractures involving body of the mandible show higher frequency of occurrence which correlates with studies of Singh V et al. 4 and differs from the studies of Shah A et al., 1 Kaura S et al., 3 Samierad S et al., 5 Bali R et al., 6 Wherein more number of fractures have been recorded in parasymphysis region according to their studies. Chandra Shekar B R et al. 7 in their study of five-year retrospective analysis of maxillofacial injuries in Mysore city shows more number of fracture cases in condylar region of the mandible.
In fractures of upper and middle 1/3, zygomatic arch region have higher number of cases which differs from the studies of Samierad S et al., 5 Chandra Shekar B R et al., 7 Ulusoy S et al. 8 where majority of injuries are seen in nasal region.
Under gender distribution, more number of fractures are seen in males than females. Ratio between males and females in this study is 9:1. Which shows similarities with the studies of Shah A et al, 1 Kaura S et al, 3 Kapoor P et al, 9 Bali R et al., 6 Chandra Shekar B R et al. 7 In the present study under the age consideration, more number of fractures are seen during third decade of life which correlates with the studies of Ramdas S et al., 2 Kaura S et al., 3 Kapoor P et al., 9 Samieirad S et al., 5 Bali R et al, 6 Chandra Shekar B R et al. 7 Open reduction and internal fixation may be preferable for some patients, particularly the elderly, to avoid the discomfort and hindrance of dental wiring. Indeed, more displaced fractures of the mandibular body will generally require open reduction and I interval fixation for optimal anatomical reduction. 10 Non displaced and minimally displaced fractures of the mandibular body can often be managed closed. 10 In this study most number of cases are treated by open reduction and fixation i.e. 66.78% and according to other studies like Shah A et al., 1 Kaura S et al., 3 Singh V et al., 4 Bali R et al., 6 Chandra Shekar B R et al., 7 also shows highest number of cases are treated by open reduction and fixation procedure.
But surgeons mostly prefer plate osteosynthesis because it offers stable and precise anatomical reduction of fragments, allows immediate recovery of function, shortens the period of bone healing and decreases the recovery period, despite the obvious advantages, it has not become popular in many developing countries mainly because of cost factors. 6 Conclusion Results of the study shows majority of injuries were in males and also in the third decade of life. Mandible was the most commonly fractured bone with body of the mandible region as the most frequent site. Open reduction and fixation remain the choice of treatment. Since most of the data are derived from hospital based institution which may show some biases while collecting information and reconstructing it.

Source of funding
None.