Hindawi Publishing Corporation

Journal of Dental Surgery

Volume 2014, Article ID 850814, 5 pages
http://dx.doi.org/10.1155/2014/850814

Research Article
Maxillofacial Fractures: Etiology, Pattern of
Presentation, and Treatment in University of Port Harcourt
Teaching Hospital, Port Harcourt, Nigeria

S. E. Udeabor, B. O. Akinbami, K. S. Yarhere, and A. E. Obiechina

Department of Oral and Maxillofacial Surgery, College of Health Sciences, University of Port Harcourt, East-West Road,
Choba 500272, Port Harcourt, Nigeria

Correspondence should be addressed to S. E. Udeabor; samudeabor@yahoo.com

Received 22 July 2014; Revised 20 October 2014; Accepted 23 October 2014; Published 6 November 2014

Academic Editor: Dennis Flanagan

Copyright © 2014 S. E. Udeabor et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective. To retrospectively analyze the pattern of presentation and modalities of management of maxillofacial fractures in our
center. Methods. The medical records of all the patients who sustained maxillofacial fractures presenting to a major referral hospital
in Niger Delta region of Nigeria were retrieved and reviewed. The data collected was analyzed using SPSS statistical package.
Results. Eighty-six patients presented with 135 maxillofacial fractures during the period under review. A male to female ration
of 3 : 1 was recorded and patients in their third decade of life were mostly affected (46.5%). Road traffic accident (RTA) was the
commonest etiology accounting for 46.5% whereas assault was second (19.8%). The mandible was the most frequently fractured
bone (59.3%) followed by the zygoma (18.5%). The main stay of treatment was closed reduction with IMF (40.4%). Conclusion.
Treatment modalities for maxillofacial fractures in our center have not witnessed any significant changes. Effort should be made to
ensure the availability of miniplates to ensure adequate treatment for all categories of our patients.

1. Introduction our environment due to the current wave of terrorism and

gun violence. Young men in the second and third decades of
Maxillofacial injuries in general occur quite commonly fol- life are the worst afflicted owing to the fact that they engage
lowing trauma and these injuries if not properly managed frequently in activities that can predispose them to trauma [9,
can negatively influence both the psychosocial and functional 10, 12]. Apart from RTA and assaults, other common causes
activities of the patient [1]. This is as a result of the centrality of of maxillofacial fractures include sporting injuries, industrial
the facial region as a key factor in human identity, esthetics, accidents, domestic accidents, falls, and animal bites [13].
and general well-being [1, 2]. These injuries can affect both The age-long principle of fracture management; reduc-
skeletal and soft tissue structures of the facial region [3, 4] and tion and immobilization also applies to maxillofacial frac-
often times, based on the etiology and mechanism of injury, tures; however, the pathway to achieving this principle is
occur in association with other systemic injuries thereby influenced by many other factors. It should be noted that
requiring multidisciplinary approach for their management the treatment outcome of maxillofacial fractures is mainly
[4–7]. dependent among other things on the degree of injury, type of
The etiologies of maxillofacial fractures vary from one fracture, the expertise of the surgeon, and available technol-
geographical location to another and also among different ogy [1, 2]. Over the years, the epidemiology of maxillofacial
age groups. Road traffic accident (RTA) has been severally fractures keeps changing and new trends in etiology, pattern
reported as the leading etiology of maxillofacial fractures of presentation, and management are constantly evolving.
especially in the developing world including Nigeria, whereas This therefore necessitates a constant appraisal of these
assault leads the pack of etiologies in the developed world injuries in order to keep abreast with recent developments
[8–11]. However, there is an increasing influence of assault in and the changing pattern of their management. This report
2 Journal of Dental Surgery

Table 1: Gender Distribution and Etiology of Maxillofacial Fractures.

Etiology
Gender RTA (MV) RTA (MB) Industrial Boat Animal Missing Data Total (%)
Gunshot (%) Assault (%)
(%) (%) (%) Accident (%) Attack (%) (%)
Male 12 (14.0) 16 (18.6) 9 (10.5) 2 (2.3) 6 (7.0) 2 (2.3) 0 (0.0) 18 (20.9) 65 (75.6)
Female 10 (11.6) 2 (2.3) 2 (2.3) 1 (1.2) 0 (0.0) 0 (0.0) 1 (1.2) 6 (7.0) 21 (24.4)
Total 22 (25.6) 18 (20.9) 11 (12.8) 3 (3.5) 6 (7.0) 2 (2.3) 1 (1.2) 23 (26.7) 86 (100)
MV: Motor Vehicle; MB: Motorbike; 𝑃-value: 0.001.

Table 2: Etiology of Maxillofacial Fractures According to Age Groups.

Age Group Etiology

(Years) RTA (MV) RTA (MB) Industrial Boat Animal Missing Data Total (%)
Gunshot (%) Assault (%)
(%) (%) (%) Accident (%) Attack (%) (%)
0–10 0 (0.0) 0 (0.0) 1 (1.2) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.2) 0 (0.0) 2 (2.3)
11–20 1 (1.2) 4 (4.7) 2 (2.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (4.7) 11 (12.8)
21–30 15 (17.4) 9 (10.5) 5 (5.8) 0 (0.0) 1 (1.2) 1 (1.2) 0 (0.0) 12 (14.0) 43 (50.0)
31–40 2 (2.3) 4 (4.7) 3 (3.5) 2 (2.3) 3 (2.3) 1 (1.2) 0 (0.0) 4 (4.7) 19 (22.1)
41–50 2 (2.3) 1 (1.2) 0 (0.0) 1 (1.2) 1 (1.2) 0 (0.0) 0 (0.0) 1 (1.2) 6 (7.0)
51–60 2 (2.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.2) 3 (3.5)
61–70 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.2) 1 (1.2)
71 and
0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.2) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.2)
Above
Total (%) 22 (25.6) 18 (21.0) 11 (12.8) 3 (3.5) 6 (7.0) 2 (2.3) 1 (1.2) 23 (26.7) 86 (100)
MV: Motor Vehicle; MB: Motorbike; 𝑃-value: 0.000.

therefore is a retrospective analysis of the etiology, pattern, and ANOVA were used for continuous variables while Chi-
and modalities of management of maxillofacial fractures in square test was used for categorical variables and 𝑃 values <
our center. 0.05 were considered as statistically significant.

2. Patients and Methods 3. Results

The medical records of all the trauma patients that presented A total number of 86 patients sustained 135 maxillofacial
to the department of Oral and Maxillofacial Surgery, Uni- fractures during the period under review. Males were 65
versity of Port Harcourt Teaching Hospital, between 2007 (75.6%) and females were 21 (24.4%) with a male to female
and 2013 (6 years) were retrospectively reviewed. The vari- ratio of 3 : 1 (Table 1). A significant male preponderance was
ables obtained include patient’s age, gender, mechanism of observed among the different age groups and for the various
injury/etiology, type of maxillofacial fracture sustained, site etiologies (Table 2). Patients’ ages ranged from 4 years to 76
of fracture, and treatment given. The mandibular fractures years with those in the third and fourth decades of life mostly
were broadly categorized into fractures of the condyle, ramus, affected (46.5% and 22.1%, resp. (Table 2)). Road traffic
angle, body, parasymphysis, symphysis, and lower alveolar accident (RTA) was the commonest cause of maxillofacial
bones. fractures accounting for 46.5%; assault was second (19.8%),
Midfacial fractures were also classified into maxillary whereas animal attack was the least among the causes (1.2%)
(Le Fort I, II, III, and IV) fractures, zygomatic complex (Table 1).
fractures, orbital fractures, upper alveolar bone fractures, and A total of 80 (59.3%) mandibular fractures were recorded,
nasoorbitoethmoidal (NOE) fractures. Fractures involving making it the most frequently fractured bone of the max-
the frontal region were also documented and when a patient illofacial skeleton. This was followed by zygomatic complex
sustained multiple fractures in the upper, middle, and lower fractures 25 (18.5%) and maxillary fractures 19 (14.1%). In
facial skeletons, they were recorded as panfacial fractures. the mandible, the body had the highest number of fractures
The various methods of treatment and reasons for treatment as opposed to the ramus, which was the least fractured site
choice as well as any modification were documented. (Table 3).
Analysis of the data was done using SPSS version 16 and Thirty-eight patients (40.4%) had their fractures treated
results were presented. Frequency distribution of variables by closed reduction and intermaxillary fixation (IMF) mak-
were generated and measures of central tendency were ing it the commonest modality of treatment for maxillofacial
calculated to summarize the numerical data. Student’s 𝑡-test fractures in our center (Table 4).
Journal of Dental Surgery 3

Table 3: Maxillofacial fracture pattern. as the most frequent cause of maxillofacial fractures in the
developed world [8–11]. The reasons for this high rate of RTA
Hard tissue Type of fracture Frequency Percentage (%)
in Nigeria include poor road networks, improper licensing
Condylar 5 3.7 of drivers/riders, nonusage of seat belts, neglect of helmets
Body 32 23.7 by motorbike riders, and noncompliance with traffic rules
Parasymphysis 19 14.1 among others [4, 5, 9, 10, 13].
Mandible Symphysis 3 2.2 An earlier report in the last decade on maxillofacial
fractures from another center in Port Harcourt showed
Ramus 2 1.5
assault/violence to be the leading cause of maxillofacial
Angle 13 9.6 fractures in the region and the author adduced this to youth
Dento-alveolar 6 4.4 restiveness and excessive use of firearms [15]. The period of
Le Fort I 5 3.7 that report in question actually coincided with the peak of
Le Fort II 5 3.7 militancy in the Niger Delta region as a whole [16]. However,
Le Fort III 1 0.7 with the amnesty program of the federal government [16],
Maxilla there seems to be a reduction in assault/violence in the region
Le Fort IV 1 0.7
as is evident from this present study.
Palatal split 1 0.7 Despite this improvement, assault/violence in the form
Dento-alveolar 6 4.4 of terrorism is significantly on the increase in the country
Zygomatic ZC fracture 25 18.5 especially in the northern region. This might eventually turn
complex out in the near future to be the most significant etiological
Orbital Rim 1 0.7 factor of maxillofacial fractures in our nation if the current
Orbital
Blow-out 3 2.2 wave of terrorism and gun violence is not checked.
Naso-orbito- Based on the high prevalence of RTA emanating from
ethmoidal NOE fractures 4 3.0 motorbikes as is obvious from this study and other previous
complex reports [10, 13], various state governments in Nigeria have
Nasal Nasal fractures 1 0.7 banned their use for transportation especially in the major
2 1.5
cities. This obviously will go a long way in reducing the rate
Frontal bone
of motorbike-related accidents. However, alternative means
Total 135 100 of transportation and mass transit like the rail system should
be adequately developed to cater for the transportation needs
Table 4: Treatment modalities for maxillofacial fractures. of the teeming populace.
Mandibular fracture was the highest occurring fractures
Treatment given Frequency Percentage (%)
from this review accounting for 59.2% of the total fractures.
Conservative 3 3.2
This is in agreement with other reports from across Nigeria
Debridement + Soft tissue repair 12 12.8 [10, 17] but differs from studies from the western world where
ORIF + IMF 29 30.9 nasal bone fractures [5] and zygomatic complex fractures [18]
Closed red + IMF 38 40.4 occur more frequently. The main fracture site in the mandible
Closed red + Suspension 4 4.3 is the body, which accounted for 40% of the total mandibular
Splinting 8 8.5 fractures from the present study. This result agrees with
Total 94 100 worldwide literature [5, 10, 17]. In the middle third, the
zygoma is the most involved site due to its projection and
multiple articulations with other facial skeletons making it
4. Discussion very vulnerable to fractures on impact [4, 18].
The place of open reduction and internal fixation (ORIF)
Fractures of the facial skeleton are commonplace following with miniplate osteosynthesis in the surgical management
trauma and therefore form a major part of the overall duty of maxillofacial fractures cannot be overemphasized as it
of an Oral and Maxillofacial Surgeon [10, 14]. These fractures promises a shortened period of intermaxillary fixation (IMF),
occur commonest in young adults especially males in third bony union with minimal callus formation, rapid recovery
and fourth decades of life because they are majorly involved in of normal jaw functions, and maintenance of normal body
many outdoor activities and reckless driving [5, 9, 10, 12]. This weights among others [14]. Despite these advantages, its use
assertion is supported by our study in which more than 75% in our center is still a bit limited mainly due to cost and the
of the study populations were males and 68.6% were between time required to procure the plates.
the ages of 20 to 40 years. The inefficiency of the Nigerian national health insurance
Road traffic accidents (RTA) were by far the leading scheme means that patients still have to directly pay for their
cause of maxillofacial fractures from our study accounting treatments and only a few of our patients can afford the use
for 46.5% of the total. This is in keeping with results from of miniplate osteosynthesis for their fracture management.
other studies, which reported RTA as the leading cause of Therefore, most of our patients were treated by nonrigid
maxillofacial fractures especially in the developing world osteosynthesis (transosseous wiring) or closed reduction with
including Nigeria. Assault, on the other hand, is reported a long period of IMF (6 weeks). This is virtually the situation
4 Journal of Dental Surgery

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The authors declare that there is no conflict of interests
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