The Prevalence and Pattern of Oral and Maxillofacial Injuries in Al Fujairah Population, UAE- A Retrospective Study

1. INTRODUCTION

Maxillofacial injuries pose a remarkable challenge to healthcare services globally due to their high rate of occurrence, mortality, and financial insinuations [1]. The World Health Organisation has stated that rapid industrial growth and population explosion in developing as well as developed countries have resulted in lifestyle modification, which in turn has led to an alarming rise in trauma rates, especially involving fractures of the maxillofacial region, owing to its specific anatomical location in the human body [2]. The maxillofacial region succumbs to maxillofacial injury, whose magnitude and causative factors diversify within the same geographical locality. This diversity is observed due to its multifactorial nature, which includes cultural, economic, social, and environmental factors [3]. These facial injuries may lead to considerable deformity or morbidity, which has serious repercussions on the individual's quality of life and productivity. The predominant causative factor for maxillofacial injuries on a global scale is road traffic accidents (RTA). In addition, falls, attacks and industrial accidents are secondary in the array of lists. Though RTAs are reported to be the leading cause of head and neck injuries in developing countries, communal or social-emotional violence contributes the same in developed countries [4].

Facial trauma can cause physical, functional, and aesthetic damage, ranging from simple injuries to complex ones involving skeletal structures [5]. Recent studies reveal a significant prevalence of oral and maxillofacial injuries, especially in severe accidents or traumatic incidents. Maxillofacial trauma cases exhibit a distinct epidemiology, characterized by more severe injuries and an increased incidence of both soft and hard tissue injuries. Facial gunshot injuries are infrequently documented yet can yield devastating outcomes [6]. Males in Sub-Saharan Africa experience a higher incidence of facial fractures than females, likely attributable to violence, falls, and societal expectations of conventional male roles [1]. Thus, periodic assessment of the etiology of maxillofacial injuries facilitates the formulation of preventive strategies.

Sports injuries mostly involve soft tissue, and the incidence of maxillofacial injuries is generally low, suggesting that sports are relatively safe for the maxillofacial complex [7]. Bite wounds are a special area of traumatology due to their high propensity for complications. Mammalian bites account for 10% of patient management, with dogs being the most common perpetrator. Human bites are more serious due to higher infection rates, with most occurring during fights and sexual assaults [8]. In addition, traumatic dental injuries constitute an unneglectable facet of maxillofacial injuries. These injuries, especially in children and young adults, account paramount public health burden [9]. Dental injuries and those of the surrounding maxillofacial region are frequent in occurrence and have been estimated to have affected around 25-30% of the permanent dentition globally, eventually causing functional disability and aesthetic concerns [10]. It has been previously demonstrated that conditions such as Class II malocclusions, Class II Skeletal sagittal pattern, and increased overjet and facial divergence are some of the significant risk factors for such injuries [11]. Moreover, individuals with orthodontic treatment needs and lower socioeconomic status have exhibited a strong positive correlation with the occurrence of traumatic dental injuries [12].

The above-mentioned estimates justify treatment priorities for maxillofacial injuries, which are utmost warranted. Therapeutic intervention must commence without delay, as airway blockage represents the most critical and urgent life-threatening consequence. Initial wound management is crucial for infection prevention. Nasal skeleton and soft tissues often require surgical repair, using autogenous grafts for primary reconstruction and secondary revision surgery. Multidisciplinary teams may also be required [13].

As the face is fundamental for every individual's unique identity, it plays a pivotal role in social reception. Thus, the targets of such injuries are affected psycho-socially and aesthetically, which, in turn, leave a considerable impact on communal relationships, employment prospects, and societal integrity. This further underscores the necessity to regularly verify the frequency and patterns of maxillofacial injuries [14, 15]. The study's findings are intended to address this ceaseless issue, which may aid in deploying preventive strategies to abate the incidence and ensuing morbidities caused by maxillofacial injuries.

There exists evidence in the literature regarding the epidemiological characteristics of maxillofacial trauma. However, there is limited data regarding this from the state of Al Fujairah, UAE. Therefore, the study aimed to explore the prevalence and trends of maxillofacial injuries among patients at Al-Fujairah Hospital, UAE, focusing on gender distribution, affected age groups, common causes, injury locations, associated soft tissue damage, diagnostic methods, and treatment approaches.

2. MATERIAL AND METHODS

The Research Ethical Committee of the Hamdan Bin Mohammed College of Dental Medicine (HBMCDM) and the Ethical Committee of the Ministry of Health and Prevention (MOHAP) approved the undertaking of this study.

This retrospective, descriptive hospital-based study was carried out at Al Fujairah Hospital, UAE, within the Oral and Maxillofacial Surgery and Emergency Medicine departments. Data was collected from January 2003 to February 2015, including archival access. Al Fujairah Hospital is the largest referral hospital in the region and serves as the sole referral centre for all complex oral and maxillofacial injuries in the state. Therefore, the sample derived from the hospital database is considered to be a true representation of the entire state's cases. The study assessed complete patient records from individuals who sought treatment for oral and maxillofacial injuries in these two departments.

3. RESULTS

3.4. Diagnostic Imaging Methods Employed

Regarding the radiological investigations (Table 3), OPGs were most commonly used for diagnosing mandibular fractures. In contrast, CT scans were widely used to diagnose midfacial injuries, and the differences were statistically significant.

Table 1.

Victims of Trauma	Origin	No	Yes	Total	Chi-square	p-value
Car driver	UAE	77(71.3%)	31(28.7%)	108(59.3%)	299.6	<0.001*
	Expatriate	69(93.2%)	5 (6.8%)	74 (40.7)
	TOTAL	146(80.2%)	36(19.8%)	182 (100%)
Car passenger	UAE	105(97.2%)	3 (2.8%)	108(59.3%)	163.4	0.673
	Expatriate	72 (97.3%)	2 (2.7%)	74 (40.7%)
	TOTAL	177(97.2%)	5 (2.8%)	182 (100%)
Pedestrian	UAE	108(59.7%)	0	108(59.3%)	163.5	0.407
	Expatriate	73 (98.6%)	1 (1.4%)	74(40.7%)
	TOTAL	181(99.4%)	1(0.6%)	182 (100%)
Motor Cyclist	UAE	89(82.45%)	19(17.6%)	98(54%)	177.8	0.006*
	Expatriate	72 (97.3%)	2 (2.7%)	74(40%)
	TOTAL	161(88.4%)	21(11.6%)	182(100%)

Note: *p<0.05- statistically significant.

Table 2.

Parameter	Frequency N	Percentage %
Etiology
Car driver	140	19.6
Car passenger	24	3.3
Pedestrian	4	0.5
Assault	55	7.7
Motorcyclist	82	11.4
Fall	180	25.2
Industrial	202	28.2
Others	29	4.1
Specific sites of injury
Maxilla	91	12.7
Mandible	335	46.8
Zygomatic arch	122	17
Others	168	23.5

Table 3.

Radiological Investigation	Facial Injuries	Mandibular Injuries	Total Cases	Chi-square	p-value
OPG	112 (30.6%)	253 (69.4%)	365 (58%)	533.8	< 0.001
CT-Scan	235 (88.6%)	30 (11.4%)	265 (42%)
TOTAL	347 (55%)	283 (45%)	630 (100%)

Note: *p<0.001- statistically significant.

Table 4.

Parameter	Frequency N	Percentage %
Treatment options
ORIF	324	45.3
Wiring	350	48.9
Suturing	6	0.8
Surgery	22	3.1
Medication	2	0.2
Treatment referral	13	1.7

4. DISCUSSION

The Fujairah emirate, the fifth-largest state in the UAE, has limited studies on documentation of facial injuries. With the causes varying globally and factors like climate, social trends, and population influencing the prevalence, there is a dire necessity for periodic ratification of the characteristics of such injuries. This will, in turn, pave the way for healthcare service providers and policymakers to implement strategies for preventing and managing such crucial injuries by amending the existing system of policies and healthcare facilities. The current study indicated that men experienced a greater incidence of maxillofacial injuries than women, with a male-to-female ratio of 5:1. This finding is similar to several previous reports [1]. This high frequency in men could be generally attributed to their involvement in high-risk activities such as construction, driving, and sports.

Conversely, women in the UAE predominantly engage in less hazardous social tasks, leading to a reduced frequency of injuries. However, the current study results indicate that road traffic accidents (RTA) are the most common cause of injury, accounting for 34.4% of all facial skeletal and soft tissue injuries. A previous study by Agnihotri et al., who assessed the pattern of maxillofacial injuries, demonstrated that road traffic accidents are the leading cause of facial trauma, and this could be attributed to the victims’ negligence of safety measures like usage of seatbelts or helmets and violation of traffic rules such as speeding [16]. Other studies also corroborate our findings, stating that RTAs are the leading cause of such traumatic injuries [17]. The rise in RTA in the UAE is due to the gradual increase in motor vehicles and motorcycles, which are more attractive and cheaper than commercial taxis. However, most motorcyclists are owned by youth, who often take risks and do not abide by traffic rules [18].

The predominant age group impacted is 21-40 years, perhaps indicative of increased physical activity and self-mobility. Numerous studies have indicated that the majority of injury victims were predominantly males aged between 20 and 40 years [16, 19, 20].

It was further reported that household and schoolyard accidents are major contributors to facial injuries in children and adolescents, as these environments often present various trauma risks [21, 22]. Such injuries typically occur through mechanisms like falls, collisions, or impacts with objects. In households, furniture and stairs are common hazards, especially for younger children, with falls being the leading cause of facial fractures. Additionally, accidental contact with sharp kitchen tools or hot surfaces can cause facial lacerations or burns. Toys with sharp edges or improper use pose another risk, particularly for toddlers with underdeveloped motor skills. In school settings, physical activities, especially contact sports like football and basketball, are prominent causes of facial injuries [23, 24].

The study found that mandibular fractures were more common in patients with facial trauma compared to mid-facial fractures. Due to its prominent anatomic location in the facial region, the mandible renders it more vulnerable to fracture. The high incidence of mandibular fracture has also been reported by several previous studies, constituting the same reason [20, 25]. The management of facial soft tissue injuries is a substantial component of the responsibilities of oral and maxillofacial surgeons. Lacerations were identified as the most common type of soft tissue injury, which agrees with previous studies, which reported lacerations and abrasions as the most prevalent [25]. A study by Gassener et al. reported that soft tissue injuries commonly involve the lips extraorally, the gingiva, the buccal mucosa, and the tongue intraorally [26].

The treatment rendered to patients mainly involved open reduction and internal fixation, with intermaxillary fixation being regarded as the principal mode of treatment. Previous studies have also considered this treatment modality the most commonly utilized one. Any difference in the treatment provided may be attributed to the site and severity of the injuries and the hospital policies [27, 28]. The results indicate the necessity for specific interventions and improved treatment regimens for maxillofacial fractures. Future research should investigate the underlying causes, develop awareness campaigns, and conduct longitudinal studies.

CONCLUSION

This retrospective study highlights the prevalence, etiology, and patterns of maxillofacial injuries in the Al-Fujairah population. Road traffic accidents emerged as the leading cause of these injuries, predominantly affecting young adult males, with mandibular fractures being the most common type. The findings underscore the need for targeted preventive measures, such as public awareness campaigns, stricter enforcement of road safety regulations, and improved use of protective devices like seatbelts and helmets.

REFERENCES