Profile of patients affected by trauma in the oral and maxillofacial complex in a hospital in the north of Piauí

Perfil de pacientes acometidos por trauma no complexo bucomaxilofacial: um estudo epidemiológico em um hospital no norte do Piauí

ABSTRACT

Objective:

The objective of this work is to analyze and describe the profile of patients affected by trauma to the oral and maxillofacial complex treated in a hospital in the north of Piauí.

Methods:

The medical records of patients undergoing surgical treatment by the Oral and Maxillofacial Surgery and Traumatology Team of the Chagas Rodrigues Regional Hospital were evaluated, since the beginning of the program, between July 2022 and October 2023.

Results:

It was observed that male individuals in the 32-year-old age group are the most affected by facial trauma, corresponding to 80,68% of cases, with a predominance of injuries in the orbito-zygomatico-maxillary complex (OZMC), accounting for 39,56% of the total fractures in this study, with motorcycle accidents as the main etiological factor (76,14%), in these cases, the most common treatment procedure was osteosynthesis of the orbito-zygomatic-maxillary complex (32,97%).

Conclusion:

It is concluded that trauma should not only be seen as a medical complication, but also as a social and economic problem, therefore it is necessary to create and implement traffic awareness and prevention measures regarding facial trauma.

Indexing terms
Facial injuries; Fractures bone; Oral and maxillofacial surgeons

RESUMO

Objetivos:

O objetivo desse trabalho consiste em analisar e descrever o perfil dos pacientes acometidos por traumatismos no complexo bucomaxilofacial tratados em um hospital, no norte do Piauí.

Métodos:

Foram avaliados os prontuários dos pacientes submetidos a tratamento cirúrgico pela Equipe de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Regional Chagas Rodrigues, desde o início do programa, compreendido entre julho de 2022 a outubro de 2023.

Resultados:

Observou-se que indivíduos do sexo masculino, na faixa etária dos 32 anos de idade, são os mais acometidos por traumas faciais, correspondendo a 80,68% dos casos, que houve uma predominância de injúrias no complexo órbito-zigomatico-maxilar (COZM), sendo responsável por 39,56% do total de fraturas deste estudo, tendo como principal fator etiológico os acidentes motociclísticos 76,14%, nesses casos, a conduta de tratamento mais realizada foi a Osteossíntese do Complexo Órbito-Zigomático-Maxilar (32,97%).

Conclusão:

Conclui-se que o trauma não deve ser visto apenas como uma complicação médica, mas também como um problema social e econômico, portanto torna-se necessário a criação, implementação de medidas de conscientização no trânsito e prevenção a respeito dos traumatismos faciais.

Termos de indexação
Traumatismos faciais; Fraturas ósseas; Cirurgiões bucomaxilofaciais

INTRODUCTION

Traumas have a significant importance today, being one of the main causes of morbidity and mortality, according to data from the World Health Organization (WHO), they are among the main causes of death and disability in the world and it is estimated that, each year, 1.24 million people die as a result of them [¹].

Among the various injuries observed in trauma care centers, facial trauma is among the most prevalent. The face is a part of the body that is normally exposed without external protections, and when traumatized results in serious injuries [²]. Such facial traumas are characterized by involving the three thirds of the region: upper, middle and lower, and the trauma can be restricted to each one in isolation, to two or it can affect the three thirds simultaneously, with repercussions on different treatment and rehabilitation approaches [³].

Oral and maxillofacial fractures result in injuries to the soft tissues, teeth, maxillomandibular region, zygoma, nose bones (NB), naso-orbitoethmoidal complex (NOE) and supraorbital structures. Such injuries, when not corrected in a favorable time and in an appropriate manner, can evolve to functional sequelae and in the individual’s appearance, in most cases leading to numerous damages to the patient, and even death [⁴].

Facial trauma is a subject of great importance, as it is an increasingly frequent medical emergency. Its etiology is multifactorial, and is related to several factors, such as: violence, age, gender, social class, place of residence and in the last 4 decades it is directly related to the increase in accidents involving motor vehicles and urban violence. They stand out not only for their importance and great prevalence, but also for bringing emotional, functional and aesthetic repercussions, permanent or not [²].

In view of the above, it is evident in the literature that Brazil has a high rate of fractures in the oral and maxillofacial complex, however, it is also noted that the number of epidemiological studies is still quite small. As a result, the need arose to identify the profile of patients affected by trauma in the oral and maxillofacial complex treated at a Regional Hospital in the north of Piauí.

In this context, this research aimed primarily to identify the epidemiological profile of patients, in addition to the most prevalent etiological agents and the most frequent types of trauma and treatments and, secondarily, to evaluate whether the absence of helmet use and alcohol abuse have an influence on occurrence of such traumas, in order to promote better health care in planning the treatment of maxillofacial fractures, better structuring of care and consequent improvement in the lives of this same population [⁵].

METHODS

The present study was an observational, cross-sectional and analytical field research, with a quantitative approach. In this type of research, researchers do not interfere in the phenomena in studies, they only observe them in a systematized way, collecting and recording information and data, to later proceed to their analysis [⁶].

The place chosen for the research was the Chagas Rodrigues Regional Hospital, located in the municipality of Piripiri, in the state of Piauí. Data collection was carried out at the Medical and Statistical Archiving Sector (SAME) of the aforementioned hospital, after approval by the ethics committee of the Federal University of Delta do Parnaíba (UFDPAR), with opinion number: 6,068,471 and after consent through the Letter of Authorization of the Co-Participating Institution. (Annex)

The medical records of patients undergoing surgical treatment by the Oral and Maxillofacial Surgery and Traumatology Team of the Chagas Rodrigues Regional Hospital, from the beginning of the program, in July 2022 to October 2023, were included. These medical records presented all the information necessary for the development of the research, such as: age, gender of the patient, location and cause of the fracture. To collect these data, a specific collection form was used for fractures in the oral and maxillofacial complex. It is also noteworthy that a term of commitment for the use of data was prepared and during the performance of the analyses, the confidentiality of all the information collected was maintained, preserving the identity of the patients.

Medical records of patients undergoing surgical treatment by other specialties, as well as those referred to other hospitals, as well as erased or ineligible medical records, were excluded.

The research contributed to the understanding of the profile of patients affected by oral and maxillofacial fractures in the city of Piripiri-PI, enabling the elaboration of public policies aimed at the prevention of these injuries, generating a possible reduction in public spending, in addition to improving the services offered by the government, structuring care and consequently, providing an improvement in the lives of this same population.

It is also emphasized that the data will be preserved by the researcher in charge in a safe place, for a period of 5 years, in the private collection of the library of Christus Faculdade do Piauí (CHRISFAPI), and will only be used for the purpose intended for the research.

RESULTS

In total, 91 medical records were analyzed, and 3 were dismissed due to the criteria for exclusion from work. Based on the data collected, it was evidenced that the profile of patients most affected by fractures in the oral and maxillofacial complex is mostly male, with 71 individuals, corresponding to 80.68% of the cases, and only 17 (19.32%) are female. Age ranged from a mean of 32.54 (± 12.90). As for the municipalities of origin, 8 municipalities stood out: Piripiri, which had the highest number of occurrences, with 43 patients (48.86%), followed by Brasileira with 7 patients (7.96%) and Barras with another 6 (6.82%) (table 1).

Table 1
Sociodemographic statement (gender, age and municipality of origin).

Variable		Average	Standard deviation	Absolute Frequency(n)	Relative Frequency (%)
Age		32.54	12.90	-	-
Sex
	Male			71	80.68
	Female			17	19.32
Municipalities of origin
	Piripiri			43	48.86
	Brasileira			7	07.95
	Barras			6	06.82
	Batalha			5	05.68
	São José do Divino			5	05.68
	Capitão de Campos			4	04.55
	Pedro II			4	04.55
	Piracuruca			2	02.27
	Other			12	13.64
Total				88	100

• Note: Finally, as this is a study with a quantitative and analytical approach, the Microsoft Office Excel program was used to organize the findings, which were expressed in tables and graphs for a better discussion of the mathematical correlations between the results, it is worth noting that the level of significance adopted was 5%, in view of the quantitative data contained in this research.

The data collection period was divided into 5 quarters and 1 bimester, highlighting the months of October to December 2022, with the registration of 22 cases, followed by April to June 2023 with 18 cases, in addition to October and November 2023 with 15 cases (figure 1).

Figure 1
Demonstration of the number of patients with trauma to the maxillofacial complex treated at the service included in the study. Piripiri – PI.

As for the etiological agents, 6 groups were defined: traffic accidents (car accidents and motorcycle accidents), physical aggression, accidents due to firearm projectiles (PAF), domestic accidents, work accidents, and sports accidents. The main etiological factor related to facial fractures was traffic accidents, more specifically motorcycle accidents, accounting for 67 cases (76.14%). Followed by car accidents, physical aggression and sports accidents, each with 03 cases, representing 10.23% of the total (table 2).

Table 2
Demonstration of the causes of fractures according to data collection.

Variable		Absolute Frequency(n)	Relative Frequency (%)
Causes of fracture
	Motorcycle accident	67	76.14
	Car accident	3	03.41
	Physical aggression	3	03.41
	Sports accident	3	03.41
	Domestic accident	2	02.26
	Occupational accident	1	01.14
	Other	9	10.23
Total		88	100

Regarding the use of helmets and alcohol by the traumatized individuals, it was observed that of the 67 victims of motorcycle accidents, 23 (34.33%) did not use a helmet and only 01 (1.49%) used it when riding motorcycles and 43 (64.18%) did not have any type of record in the medical record (table 3). Regarding alcohol use, 10 patients (12.82%) were under the influence of the substance and 68 (87.18%) did not have any type of information about it in their medical records (table 4).

Table 3
Demonstration of helmet use according to data collection.

Variable		Absolute Frequency(n)	Relative Frequency (%)
Use of helmet
	Yes	1	01.49
	No	23	34.33
	Unregistered	43	64.18
Total		67	100

Table 4
Statement of alcohol consumption according to data collection.

Variable		Absolute Frequency(n)	Relative Frequency (%)
	Alcohol consumption
	Yes	10	13,46
	No	0	00,00
	Unregistered	68	87,18
Total		78	100

Regarding the areas involved, 91 traumas were recorded, divided into: nose bones (NB), orbitozygomatic-maxillary complex (OZMC), mandible and zygomatic bone. The most prevalent fractures were fractures in the OZMC, with 30 cases representing 32.97% of the total, followed by fractures in the bones of the nose, with 28 cases recorded (30.77%) (table 5). The approach adopted to treat the traumas that occurred was also evaluated (table 6), with osteosynthesis of fractures of the OZMC being the most used, representing 32.97% of the cases.

Table 5
Demonstration of fractured sites according to data collection.

Variable		Absolute Frequency(n)	Relative Frequency (%)
Fracture site
	OZM Complex	36	39.56%
	Bones of the nose	28	30.77%
	Zygomatic bone	14	15.38%
	Jaw	13	14.29%
Total		91	100

Table 6
Statement of processing conducts according to data collection.

Variable		Absolute Frequency (n)	Relative Frequency (%)
Treatment conduct
	Osteosynthesis of OZMC fracture	30	32.97%
	Closed NB fracture reduction	28	30.77%
	Closed reduction of zygomatic bone fracture	14	15.38%
	Osteosynthesis of mandibular fracture	8	08.79%
	Osteosynthesis of mandibular symphysis fracture	2	02.20%
	Other	9	09.89%
Total		91	100

DISCUSSION

Traumas in the oral and maxillofacial complex are considered a major problem for society, because in addition to causing aesthetic, functional and psychological damage to the individual, they entail high expenses in the field of public health, corresponding to about 4% and 7% of the health budget in Brazil [⁷]. Based on this, carrying out an epidemiological survey of facial injuries is essential for better planning and evaluation of public health.

Based on the analysis carried out in this study, it was evidenced that male individuals, around 32 years of age, are the most affected by facial trauma, corresponding to 80.68% of the cases. These results are in agreement with other evidence in the literature, which justifies that men are more prone to risky and violent activities, such as inappropriate maneuvers, alcohol and drug abuse, in addition to non-adherence to laws and non-use of safety equipment, the result of a social construction permeated by characteristics such as: strength, competition, virility and aggressiveness [⁸].

The etiologies of trauma vary according to each region and the socioeconomic factors of the population studied. Studies carried out in municipalities in the interior show motorcycle accidents as the main cause of fractures, while studies carried out in capitals have interpersonal violence as the main etiological factor, followed by traffic acidentes [⁹].

These data were also corroborated in this study, since according to the information collected, the inland municipality of Piripiri was the place with the highest occurrences of cases, with a total of 43 patients (48.86%), with the main etiological agent being motorcycle accidents, corresponding to about 76.14% of the cases, of which, 34.33% did not use a helmet. The literature shows that there is a close relationship between the incidence of facial fractures and traffic violations, such as: not wearing a seat belt, as well as not wearing a helmet, exceeding the allowed speed limit and drinking alcohol [¹⁰]. Regarding the use of alcohol, the medical records of patients who suffered domestic, motorcycle, automotive accidents, physical aggression and falls were evaluated, with this, it was observed that only 12.82% of the individuals were drunk.

However, the data regarding the absence of helmet use and alcohol consumption may be much higher than those recorded, as 64.18% of the medical records analyzed did not present any record regarding the use of this safety equipment and 87.18% of the medical records did not have any information about the consumption of alcoholic beverages, reinforcing other studies in the literature that show that most of the time these records are neglected in the initial care of the patient, victim, becoming subjective data [¹¹].

Regarding the period with the highest occurrence of fractures, the months of October to December 2022 stood out, with the registration of 22 cases, followed by April to June 2023 with 18 cases and October and November 2023 with 15 cases. It was observed that the highest incidence of cases recorded was in periods of atypical movements in the region. Such an increase is related to local holidays and festivities that cover the months of April to December in the region. Although the literature on the influence of tourist seasonality and festivities on the increase in morbidity and mortality is scarce, a study conducted by Silva [¹²] showed that commemorative periods influence the increase in deaths and hospitalizations due to external causes, in addition, it was highlighted that months such as September, October, November, December have the highest number of accidents, corroborating the data collected by the present study.

Regarding the most prevalent types of fractures, there was a predominance of traumas of the orbitozygomatic-maxillary complex (OZMC), accounting for 39.56% of the total fractures in this study. In second place were fractures of the bones of the nose, corresponding to 30.77% of the cases, followed by zygoma fractures alone, representing 15.38%. The main justification revolves around the fact that both the bones of the orbitozygomatic-maxillary complex and the nasal bones are characterized by being the most prominent structures of the face, making them susceptible to traumatic injuries more frequently [³,⁴], other studies similar to this study corroborate these data [¹³]. However, there is a disagreement among the authors researched, where fractures in the mandible were more prevalent, associating it with the fact that it is the only bone with mobility, being more subject to injuries [⁴,¹⁴]. In this study, only 14.29% of the traumas correspond to mandibular fractures, covering areas such as the condyle, ramus, symphysis, angle and mandibular body.

Facial trauma represents a great challenge to the oral and maxillofacial surgeon, as any inappropriate conduct can result in deformities, severe aesthetic and functional impairment [¹⁵]. Regarding the type of approach most adopted, there was a prevalence of Osteosynthesis of the Orbitozygomatic-Maxillary Complex (32.97%) and Closed Reduction of the bones of the nose (30.77%), since they were the most affected regions. In addition to these modalities, the conservative method for zygomatic bone fractures, called Closed reduction of zygomatic bone fracture, using Hook of Barros, was also highlighted, representing 15.38% of the treatment modalities.

Although the present research presented social risks such as privacy violation, breach of confidentiality and return of inappropriate communication of data, professional ethics were maintained and it is affirmed that the information collected had its privacy preserved. In addition, some difficulties, such as lack of information in some medical records and the obsolete system of medical record storage used by the hospital in question, made it difficult to obtain a greater amount of data, but such objections did not make it impossible to carry out the research.

It is evident that trauma should not be seen only as a medical complication, but also as a social and economic problem that causes damage and very high costs for both the individual and public health and deserves greater attention from institutions [¹⁶].

Finally, the findings provide data for a better understanding of the profile of patients affected by trauma in the oral and maxillofacial complex of the population studied, clarifying the main etiological factors, the most traumatized areas and the most performed treatments, enabling better planning, better structuring of care, a possible reduction in public spending and consequent improvement in quality of life of the population and professionals.

CONCLUSION

In view of the above, it is concluded that male individuals, in the age group of 32 years, are the most affected by facial traumas, corresponding to 80.68% of the cases, there was a predominance of traumas in the orbitozygomatic-maxillary complex (OZMC), being responsible for 39.56% of the total fractures in this study, with motorcycle accidents as the main etiological factor (76.14%) and the most performed treatment approach was Osteosynthesis of the Complex Orbitozygomatic-maxillary (32.97%). Therefore, it is essential to improve or create new policies to prevent traffic accidents and campaigns to encourage the use of helmets. In addition, it is necessary to properly fill out the medical records, from the initial care to the patient, standardizing data collection, thus facilitating communication between professionals and minimizing the neglect of important information. To conclude, as this is a relatively recent program, started in July 2022, new studies with a larger sample size and a longer collection period are indicated for the implementation of more specific policies.

How to cite this article

• Medeiros ALS, Torres LA, Costa Neto AM, Dias, Leal ES, Coelho RMI. Profile of patients affected by trauma in the oral and maxillofacial complex in a hospital in the north of Piauí. RGO, Rev Gaúch Odontol. 2024;72:e20240031. http://dx.doi.org/10.1590/1981-86372024003120230121

REFERENCES

• ¹
  Agudelo-Suárez A, Duque-Serna FL, Restrepo-Molina L, Martínez-Herrera E. Epidemiología de las fracturas maxilofaciales por accidente de tráfico en Medellín (Colombia). Gac Sanit. 2015;29(S1): 30-5.
• ²
  Scannavino FLF, Santos FS, Neto JPN, Novo LP. Análise epidemiológica dos traumas bucomaxilofaciais de um serviço de emergência. Rev Cir Traumatol Buco-Maxilo-fac. 2013;13(4):95-100.
• ³
  Zamboni RA, Wagner JCB, Volkweis MR, Gerhardt EL, Buchmann EM, Bavaresco CS. Levantamento epidemiológico das fraturas de face do Serviço de Cirurgia e Traumatologia Bucomaxilofacial da Santa Casa de Misericórdia de Porto Alegre - RS. Rev Col Bras Cir. 2017;44(5):491–7.
• ⁴
  Ramos JC, Almeida ML, Alencar YCG, Sousa LF, Figueredo CHMC,Almeida MSC. Estudo epidemiológico do trauma bucomaxilofacial em um hospital de referência da Paraíba. Rev Col Bras Cir. 2018 45(6): e1978.
• ⁵
  Porto DE, Costa RD, Porto E. Perfil epidemiológico dos pacientes com lesões buco-maxilofaciais: contribuições para a eficiência dos processos de gestão hospitalar. Rev Cir Traumatol Buco-Maxilo-fac. 2018;18(2):16-24.
• ⁶
  Echeimberg JO, Raimundo JZ, Leone C. Tópicos de metodologia de pesquisa: estudos de corte transversal J Hum Growth Dev. 2018;28(3):356-360.
• ⁷
  Mendes N, Ferreira BCB, Bracco R, Martins MAT, Fonseca EV, Souza DFM. Perfil epidemiológico dos pacientes portadores de fraturas de face. Rev Assoc Paul Cir Dent. 2016;70(3):328-329.
• ⁸
  Silva CJP, Ferreira RC, Paula LPP, Haddad JPA, Moura ACM, Naves MD, Ferreira EF. Traumatismos maxilofaciais como marcadores de violência urbana: uma análise comparativa entre gêneros. Cien Saude Colet. 2014; 19(1):127-136.
• ⁹
  Moura MTFL, Daltro RM, Almeida TF. Traumas faciais: uma revisão sistemática da literatura. Rev Fac Odontol UPF. 2016;21(3):331-7.
• ¹⁰
  Maia SES, Cardoso IS, Moreira TCA, Silva KRV, Silva TF. Análise epidemiológica das fraturas dos ossos da face em um hospital público no nordeste do Brasil. Rev Cir Traumatol Buco-maxilo-fac. 2022;22(1):6-12.
• ¹¹
  Martins RHG, Ribeiro CBH, Fracalossi T, Dias NH. A lei seca cumpriu sua meta em reduzir acidentes relacionados à ingestão excessiva de álcool? Rev Col Bras. Cir. 2013; 40(6):438-442.
• ¹²
  Silva PC da, Camacho LAB, Carmo CN do. Impacto do efeito calendário na morbimortalidade por causas externas em municípios turísticos no Estado de São Paulo, Brasil, no período de 2004 a 2014. Cad Saúde Pública. 2021;37(1): e00174019.
• ¹³
  Farias IPSE, Bernardino ÍM, Nóbrega LMD, Grempel RG, D’Avila S. Maxillofacial trauma, etiology and profile of patients: an exploratory study. Acta Ortop Bras. 2017;25(6):258-261. http://dx.doi.org/10.1590/1413-785220172506152670
  » https://doi.org/10.1590/1413-785220172506152670
• ¹⁴
  Silva NKS, Marques AL, Almeida-Marques RVD. Perfil das fraturas faciais em um serviço de emergência no Maranhão. Rev Cir Traumatol Buco-maxilo-fac. 2019;19(1):8-13.
• ¹⁵
  Mendonça JCG, Crivelli DMB. Tratamento de fratura cominutiva do complexo zigomático orbitário com utilização de fio de aço: relato de caso. Rev Bras Cir Cabeça Pescoço. 2012; 41(2):93-5.
• ¹⁶
  Silva AC. Análise epidemiológica e avaliação do tratamento e das complicações dos casos de trauma facial atendidos na FOP - Unicamp, no período de abril de 1999 a março de 2000 [dissertação]. Piracicaba (SP): UNICAMP; 2001.

Edited by

Assistant editor: Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  11 Nov 2024
• Date of issue
  2024

History

• Received
  22 Dec 2023
• Accepted
  28 June 2024