A 25-year-old male truck driver presented to Emergency Department following unrestrained heavy motor vehicle crash (MVC), when the high-speed truck collided to a wall. He sustained blunt chest trauma from steering wheel and open fracture of right tibia with compartment syndrome. On primary survey, patient was in shock with patent airway. Focused assessment sonography for trauma (FAST) suggested cardiac tamponade for which ultrasound-guided pericardial catheter was placed. After resuscitation patient was taken to the operation theatre. Clam-shell thoracotomy revealed rents in left atrial appendages which were repaired. Fasciotomy of leg was performed and external fixator was applied for open tibia fracture. The patient developed surgical site infection that was treated with local antibiotic and regular dressings. After two weeks, fasciotomy wound was closed with split-skin grafting. At nine-month follow-up, patient was able to resume his occupation as a heavy motor vehicle driver.
Aims
This study aimed to obtain an update on the epidemiologic data of maxillofacial injuries with an analysis of current aetiology and associated factors encountered at a major Tertiary Care Centre of North India.
Materials and methods
This retrospective study was conducted in a Tertiary Care Centre in Uttarakhand over 2 years. The demographics, aetiology, seatbelt/helmet use, alcohol consumption at the time of injury, site of the fracture, other associated injuries and type of intervention were recorded.
Results
The male:female ratio was 4.2:1. A peak prevalence was found in the third decade (mean age 23.6). Road traffic accidents were the most common cause of trauma (76.9%). Maxillofacial injuries were higher in those who did not use a seatbelt or helmet (85.1%). Intoxication at the time of injury was a major factor, especially in accidents. Drivers were found to be injured more (74.7%) than pillion riders or passengers. The incidence of fractures was highest in monsoons (30%). Mandibular (37.8%) and zygomatic (20%) fractures were most commonly encountered. The most common site of mandibular fractures was parasymphysis (30.6%). Fractures were treated by open reduction and internal fixation. Concomitant neurological and orthopaedic injuries were common in patients sustaining maxillofacial injuries.
Conclusion
Road traffic accidents continue to be responsible for maximum trauma. A multidisciplinary assessment of every trauma victim is essential. This study can help formulate rigorous injury preventive schemes by distinguishing and analysing maxillofacial trauma. Advocation and strict implementation of helmet and seatbelt use with a heavy penalty for drinking and driving can lead to the reduction of maxillofacial injuries.
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