MATERIAL AND METHODS

In this descriptive-analytical and retrospective study which was conducted as a cross-sectional study in 2016, 361 people who were admitted to the training centers in Rasht with maxillofacial fractures entered the study. 286 of them were male and 75 were female. The majority of the participants in this study (129 people) were between the ages of 21 and 30. Information was collected through questionnaires and patients’ records who were admitted to the emergency department of Poursina and Velayat hospitals with maxillofacial fractures. The patients were examined to see whether they have brain and cervical spine injuries. The diagnosis of the fracture and brain and neck injuries had been separately written by the related doctors on the records of the patients, based on clinical examination and Plain radiography and CT scans. Cases that were incomplete for various reasons were omitted. Data was collected by questionnaires and was entered into SPSS software for analysis. To describe the data, descriptive tests were used.

RESULTS

The results of the data collection showed that traffic accidents were the most prevalent cause of the fractures in the patients of this study (61 percent). Data also showed that the pattern of maxillofacial fractures was as follows: mandibular fractures (51%), maxillary fractures (4%), zygomatic fractures (6%), frontal fractures (10%), nose fractures (10%) and compound fractures (8 percent). So, the mandible was the most common area of fractures in patients. In all fractured areas, frequency in men was more than in women. As for the fracture pattern, there was a significant difference between patients (p=0/0001) as well as between the two sexes (men and women).

In Table 1, the results of the most common injuries of the cervical spine in patients are presented.

The most common cervical spine injuries were as follows bone fractures (77.8 percent), cervical vertebrae dislocation (33.34 percent), disc herniation (11.12 percent) and spinal cord contusion (11.12 percent). Considering the types of cervical spine injuries, there was a statistically significant difference between patients (p=0/0001). In Table 2, the most common brain damage in patients is presented.

Among the different types of skull fractures, fractures of the frontal bone were of the highest frequency among patients (37.5 percent) which were followed by Ethmoid bone fractures (29.32 percent), orbital roof (16.67 percent) and the sphenoid bone fractures (13.54 percent) (p =0/041). Table 3 presents the results of treatment (recovery, death, etc.) in the studied patients.

The majority of patients (76%) left the hospital with partial recovery. 11 percent improved and 7 percent were discharged with personal satisfaction. 4% of the patients died and 2% transferred to other medical centers.

Table 1: The most common cervical spine injuries


Table 2: The most common brain injuries


Table 3: Results of treatment (recovery, death, etc) in the patients

DISCUSSION AND CONCLUSION

As discussed, trauma is one of the leading causes of death in the communities. Maxillofacial fractures are one of the main problems of trauma patients. Facial Fractures are likely to be associated with complications such as brain and spinal cord damage. With this description, this study aimed to examine the prevalence of brain and cervical damage in patients with maxillofacial fractures. The first finding of the present study was that the most important cause of maxillofacial fractures is car accidents with 61 percent. In most studies in Iran (13, 14, and 15), car accidents have also been considered as the most common cause of fractures. Also, similar results were obtained from studies of Patrocinio et al (16), Adebayo et al (17), Klenk and Kovacs (18). In a review article by Oikarinen et al (19), etiologic differences of maxillofacial fractures in Kuwait, Canada and Finland were compared. The researchers found that traffic accidents were the cause of 55 percent of fractures in Kuwait, 33 percent of fractures in Finland and 7% in Canada. These results are consistent with information obtained by the Kuwaiti researchers who showed that Eastern countries do not observe the traffic rules. However, the percentage of injuries caused by conflict in Kuwait is (12%), Finland (37%) and Canada (54 %).

The second finding of the present study is that the mandible (51%) was the most common site of fractures in patients. This finding was consistent with the findings of Akrami Abargouei et al (20) Kamoliga et al (21), Maliska et al (22), Blasilirov and Pasry (23), Karkaovik et al (24), and it is inconsistent with research of Dongas and Hall (25). Akrami Abargouei et al (20) reported that in patients with maxillofacial fractures, the most common site of involvement is the nasal bone (67.4%) followed by mandible (18.7 percent). In this study, the most common site of involvement in the mandibular condyle (31.47 percent) and the body of the mandible (26.73 percent). Dongas and Hull in their study reached the conclusion that the fracture of the middle third of the face is the most common site of involvement.

The third finding of the study is that the most common injury of the cervical spine of the subjects of this study was bone fracture (77.8%) and cervical vertebrae dislocation (33/34 %). The findings of the study were similar to those of Mokerji et al (4). In his study, fracture and dislocation of the cervical vertebrae was a total of 63 percent and disc herniation and spinal cord contusion were 37% among the patients. The researchers also noted that 70 percent of the injuries of the cervical spine have occurred at levels of C1 / C2 or C6 / C7.

The fourth finding of this study is that among various types of skull fractures, frontal bone fracture had the highest frequency in samples of this study (37.5 percent). This is consistent with the findings of Yadave et al (26). In the study of Yadave et al (26), extradural hematoma, subdural hematoma and subarachnoid hematoma in patients with maxillofacial fractures were also reported 22, 17 and 14 percent, respectively. In this study, frontal fracture, sphenoid fracture and orbital roof fracture were 21, 11 and 14 percent respectively.

Although this study has limitations including lack of generalizability of the results, according to the findings of the study, it can be summarized that the maxillofacial fractures are accompanied by brain and spinal cord injuries and this fact was confirmed in the subjects of this study. Traffic accidents were the main cause of maxillofacial fractures in this study. World Health Organization’s guidelines on the main factors in preventing accidents are as follows: the use of safety belts, helmets, seats for children, not using mobile phones while driving and improving the safety of roads. Better design of roads and highways, training courses for drivers and implementation of more serious measures should also be considered. Despite the preventive laws for mandatory use of safety devices, indices of cooperation in the society affect the performance of these safety solutions.