Maxillofacial Injury
Maxillofacial injury is injury to the facial soft tissues, facial skeleton and associated specialised soft tissues within the head and neck as a result of wounding or external violence.
The Oral & Maxillofacial Surgeon is an essential part of comprehensive Accident & Emergency Services in the management of these injuries, both primary and secondary.
In the more severe injuries, the OMF Surgeon works in close collaboration with many other specialities, in particular neurosurgical and ophthalmological colleagues.
Incidence
A population of 500,000 yields in excess of 4,000 facial injuries per year, of which 250 will be facial fractures, excluding simple nasal fractures. The incidence of facial fractures continues to rise. In the United Kingdom, the major cause of trauma to the facial area is inter-personal violence, with the incidence of injuries from road traffic accidents showing a decline in recent years.
This may be a reflection of the effectiveness of seatbelt legislation, improved car design and safety equipment, and improvements in pre-hospital care and rapid patient transfer to trauma-accredited hospitals. This has lead to an increase in the number of patients arriving at hospital with multi-system trauma and severe facial injuries.
A national facial injury survey, conducted by BAOMS in 163 Accident & Emergency Departments across the United Kingdom, identified in one week 6,114 patients who presented with facial injuries.
This study found that:
- nearly a quarter of facial injuries in all age groups were associated with alcohol consumption
- one in three of these had serious facial injuries requiring specialist treatment or hospital admission
- at least half a million facial injuries occur in the United Kingdom annually and 180,000 are of a serious nature
- assault was the cause of 25% of facial injuries, ie. at least 125,000 facial injuries per year are caused by assault
- 40% of assaults caused serious facial injuries
- 51% of assault victims had drunk alcohol within 4 hours of the injury
- 40% of all the assaults occurred in the 15-25 age group and more than 40% of these caused serious facial injury
- more women than men were assaulted in the home, nearly half of all assaults on women occurred in the home. Overall, however, 4 men were assaulted for every assault on a woman.
- road traffic accidents caused 5% of facial injuries, but more than 40% of these resulted in serious facial injury
- 1 in 6 patients involved in road traffic accidents had drunk alcohol within four hours of the injury
- 10% of patients with facial injuries caused by falls had drunk alcohol within four hours of the injury
Management
Injuries to the maxillofacial area are routinely treated by the technique of open reduction and internal fixation, using a variety of micro, mini and reconstruction plating systems. This has lead to early restoration of function and rapid rehabilitation, but there is no doubt that many serious facial injuries can cause permanent facial disfigurement and psychological distress with extensive soft tissue scarring presenting a particular challenge to the oral & maxillofacial surgeon.
Modern oral & maxillofacial surgical techniques have resulted in early restoration of function and return to work and have reduced the need for secondary reconstruction and scar revisions. It is essential that all facial injuries are referred to the oral & maxillofacial surgeon.
Reproduced by kind permission of BAOMS
Patients can be referred to the OMFS Monday morning trauma clinic by via the on call OMFS surgeon contacted via the Royal Hallamshire Hospital switchboard or the following fax number 01142717836
For more information about this service please contact
Mr N. Lee
Consultant Oral and Maxillofacial Surgeon
CCDH
76 Wellesley Road
Sheffield
S10 2SZ
