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1.

Purpose

The purpose of this study is to determine the necessity and/or effectiveness of antibiotics in cases with maxillofacial trauma and emphasise the administration of antibiotics in maxillofacial fractures indicated for open reduction and rigid internal fixation (ORIF).

Materials and Methods

This study is a single blind, prospective, randomized clinical trial composed of subjects who presented with non-comminuted, linear fractures of the mandible and were treated by ORIF via an intraoral approach. One hundred and forty-four subjects (2011–2015) who belonged to the above entities were randomly categorized into 2 groups of 72 each, on lottery method. Patients in Group A were administered a 5 day course of antibiotic (1 day IV antibiotics followed by 4 days oral) while patients in Group B received a 1 day course of IV antibiotic (1 dose post op). Both the groups were followed up on the 1st day, 3rd day, 1st week, 1st month, 3rd month post operatively and were evaluated for pain, swelling, infection, fever, spontaneous wound dehiscence, purulent discharge and any other adverse effects.

Results

Post operative infection when measured clinically and radiographically was comparatively higher in Group B. Out of 72 patients in both the groups, 5 patients each in Group A and Group B reported with wound dehiscence, 9 patients in both groups developed pyrexia.

Conclusion

Though the post operative infection was slightly more in Group B compared to Group A, 1 day antibiotic regimen was found to be equally effective when compared to 5 day regimen and helps in reducing the after effects, superinfection and antibiotic resistance. It has better patient compliance and is cost effective.
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2.

Introduction

Trauma is steadily increasing in the modern world and thus becoming a major public problem. Maxillofacial injuries constitute a substantial proportion of cases of trauma and occur in a variety of situations like road traffic accidents, interpersonal violence, falls or as a result of contact sports. The aim of this prospective study was to evaluate the efficacy of titanium mesh for osteosynthesis of maxillofacial fractures.

Materials and Methods

Fifteen patients of maxillofacial fractures who were treated with titanium mesh were included in this prospective study. The patients were evaluated preoperatively, intraoperatively and postoperatively at 7th day, 3rd week, 6th week and 12th week.

Results

The mean age of fifteen patients was 31.3 years with a male:female ratio of 14:1. The most common mode of injury was road traffic accident (86.6%). The mean time interval between injury and surgical procedure was found to be 7.6 days. The majority of fracture sites (88%) were comminuted. 93.3% of the patients achieved good occlusion by 12th week postoperatively. Postoperative complications included residual hypoaesthesia in four patients and wound dehiscence in one patient.

Conclusion

We conclude that titanium mesh is a versatile option for maxillofacial fractures. It provided good stabilization especially in comminuted fractures. As a fixation method, it was quick in placement and highly adaptable, and thus, it proved to be valuable in restoring the form and function in maxillofacial trauma patients.
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3.

Background

The world wide pattern of oral and maxillofacial surgical conditions has rarely been reported despite its significance in ensuring quality of care. A large number of patients are managed surgically in Oral and Maxillofacial Surgery department of Dhaka Dental College Hospital but there has been no surgical audit to identify the potential problems in patient care.

Objectives

The aim of this study was to identify the pattern of oral and maxillofacial conditions in patients of maxillofacial surgery of Dhaka Dental College Hospital, which would provide valuable information to build up the focus of attention, to develop a future strategy plan, to improve its clinical care and extend the academic and research field.

Patients and Methods

A retrospective survey of oral and maxillofacial surgical cases managed at the inpatient Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital. All admitted patients from 1st January, 2012 to 31st December, 2012 were included in this study. The patients’ data were retrieved from the wards registers and patient records. The data were recorded as age, sex, occupation, geographic distribution, diagnosis, treatment done and operation name. These were studied to assess the prevalence of age, sex, diseases and the name of the treatment offered. Analysis of major groups of diagnosis on the basis of age and sex was also studied. Mortality was also recorded.

Results

Between 1st January, 2012 and 31st December, 2012 a total of 768 patients were treated. Among them 494 patients were male while 274 were female, male female ratio was 1.80:1. The majority of the patients were from Dhaka division. The mean age of the patients was 33.20 years; peak age group was 15–30 years. The most common diagnosis was maxillofacial injuries (35 %), followed by oral squamous cell carcinoma (22 %) and odontogenic tumours and hamartomas (11 %). Maxillo-mandibular fixation or wiring was the main modality of treatment. The mortality rate was 0.26 % of total patients.

Conclusions

The department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital is a busy centre for specialized maxillofacial services in Bangladesh. A good number of patients with a wide range of oral and maxillofacial surgical conditions are managed here. Maxillofacial injury and oral cancer are the two most common conditions encountered here.
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4.

Background

Trigemino-cardiac reflex is a physiologic response of the body to pressure effects in the region of distribution of the trigeminal nerve. Oral and maxillofacial surgical procedures can induce the development of this reflex, which leads to significant changes in the heart rate and sinus rhythms. This study intends to evaluate the effects of this reflex in patients with facial fractures and its subsequent management.

Patients and Methods

A total of thirty-seven patients with facial fractures who reported to the Department of Oral and Maxillofacial Surgery at Basaveswar Teaching and General Hospital, Gulbarga during a period from July 2015–March 2016 were considered for the study.

Results

A male preponderance is observed with the most susceptible age group being 21–30 years. Twenty-three patients sustained mid-facial fractures alone, nine patients had isolated mandible fractures and five patients had fractures of both the mid-face and mandible. A relative bradycardia was observed in the patients with mid-facial trauma, both at the time of presentation and also during the surgical reduction of midfacial fractures which improved after completion of procedure in most of the patients. However, in two patients, the bradycardia progressed to a cardiac asystole during midface manipulation which required immediate halt of the procedure and intravenous administration of atropine.

Conclusion

Trigeminocardiac reflex though physiologic, which usually tends to subside without complications is not to be neglected in the surgeries of the maxillofacial skeleton. A propensity for unforeseen complications due to this reflex has to be avoided by meticulous monitoring of the ECG.
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5.

Purpose

To analyze the safety, efficacy and outcome of angio-embolization in the management of refractory oro-nasal bleeding in patients of severe maxillofacial trauma.

Materials and Methods

It was a retrospective analysis of 21 patients who were managed by angio-embolisation to control refractory oro-nasal bleeding in severe maxillofacial trauma from December 2010 to December 2013. The patient population included 19 males and 2 females and the age ranged from 16 to 55 years (mean age of 29.6 years). Gelfoam pledgets and coils were used as embolising agents in branches of external carotid arteries. Embolising coils were preferably used to block actively bleeding vessels on angiography.

Results

Road traffic accidents were the etiology in 17 patients and fall from height (two), assault (one) and gunshot injury (one) in the rest. Twelve (52 %) patients showed active contrast extravasation on angiography. Active arterial bleeding was observed from branches of internal maxillary [11], facial [2] and lingual arteries [4]. Gel foam embolisation alone was done in 16 patients, coil embolisation alone in two patients and both coil and gel foam embolisation in three patients. The procedures were technically successful in twenty (95 %) patients. None of the patients had procedure related complications. Nine patients (42 %) succumbed to their associated injuries later, in which five patients had severe head injuries and four patients had history of hemorrhagic shock and cardiac arrest prior to the procedure.

Conclusion

Angio-embolisation is a safe and effective technique in managing intractable bleeding in maxillofacial injuries.
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6.

Purpose

Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period.

Methods

Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015–2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City.

Results

A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures.

Conclusions

Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication.
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7.

Objectives

This paper aims to evaluate in vitro the mechanical and microstructural properties of internal fixation systems used in oral and maxillofacial surgeries.

Materials and methods

Four brands of internal fixation systems (screws and 4-hole straight plates) were selected and assigned to four groups: G1 Leibinger®, G2 Tóride®, G3 Engimplan®, and G4 Medartis®. The systems were submitted to Vickers hardness testing, metallographic and interstitial elements chemical composition analyses. Data were submitted to ANOVA and Tukey’s test for statistical analysis.

Results

Plates in groups 1, 2, and 3 showed similar microstructure and mechanical properties, different from those in G4 revealing larger grains. In all groups, the screws showed similar microstructure, with uniform arrangement and size of grains; the screws showed higher hardness values than those observed for the plates.

Conclusions

The results indicate that all materials tested are adequate for use in oral maxillofacial surgeries.
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8.

Aim

ZMC fractures are the common facial injuries. The main causes of fractures are trauma due to RTAs, assaults, falls, sports related injuries, and the civilian warfares. This study is to evaluate and review the etiology, incidence, clinical findings and treatment of ZMC fractures. A sincere effort has been put forward in the management of ZMC fractures and their efficacy is evaluated in the larger interest of the patients.

Materials and methods

In this study 101 patients having displaced ZMC fractures with insignificant medical history were reviewed to evaluate the versatility of its management, with the main emphasis on post operative stability, restoration of mouth opening, wound healing, esthetic restoration of the prominence of cheek and the complications encountered.

Results

A total of 101 patients were reviewed for the management of ZMC fractures. All the cases included were managed during the period from August 2007 to August 2009 in the Department of Oral and Maxillofacial Surgery, Mamata Dental College and Hospital, Khammam. The extremes of ages in this study ranged from 17 to 60 years with the mean of 43. RTA was the most common cause of injury. Seventy-eight patients (77 %) were managed with surgical treatment.

Conclusion

Attention should be paid to improvement in automobile safety devices and compliance by motor vehicle occupants in addition to the improvement of the rules and regulations in sporting activities.
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9.

Background and purpose

Midfacial fractures may often be associated with injuries to the orbit which may lead to notable dysfunction of the visual apparatus, if not detected early after injury. The purpose of this study is to evaluate the associated ophthalmic injuries in mid-face trauma and to emphasize the need for understanding the ophthalmic signs and symptoms by an attending maxillofacial surgeon.

Patients and methods

A total number of 60 clinically and radiographically proven subjects with midfacial fractures were considered in the study that underwent complete ophthalmological evaluation at initial presentation. Referral to ophthalmologist was considered to determine the exact nature of injury and its implications. Results by a maxillofacial surgeon and ophthalmologist were evaluated.

Results

In our study, a male predominance with a mean age of 32 years was observed, with the most common etiology being Road Traffic Accidents. Forty-two of the 60 patients exhibited sub-conjunctival hemorrhage accounting for 70 % of ocular injuries recorded. While 28 of the 60 patients displayed peri-orbital edema (53.3 %), 8 patients experienced diplopia (13.32 %) and 8 patients showed relative afferent pupillary defect (13.32 %).

Conclusion

From our study, it becomes imperative that the maxillofacial surgeon should have a thorough knowledge of the various ophthalmic injuries that could occur in association with midfacial trauma in order to prevent visual complications to the patient. Understanding of the subtle injuries to the ocular apparatus which may be undiagnosed by a maxillofacial surgeon but have significant grave outcomes is essential.
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10.

Introduction

Hemophilic pseudotumor is a rare complication occurring in patients with hemophilia, frequently seen in the femur, tibia, pelvic bones, iliac bones, or rarely in the maxillofacial region.

Case report

A 7-year-old male reported with a spontaneous extra-oral swelling that was managed with pre-operative transfusion of factor IX along with curettage of the lesion. Our report presents only the fourth case in literature wherein this tumor presented in a patient with hemophilia B.

Finding

Hemophilic pseudotumor is a rare entity in the maxillofacial region. High degree of suspicion is required for diagnosis, and close coordination between the medical and surgical teams aids in management.
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11.

Purpose

This study aimed to determine via systematic review and meta-analysis the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents.

Methods

A systematic review of articles published from 2006 to 2015 (10 years) in English language was performed. The following databases were used: PubMed/MEDLINE, Scopus, and Web of Science. Observational studies reporting the number of children and/or adolescents who suffered maxillofacial trauma resulting from different etiologies were included. Studies were selected by two independent reviewers (Kappa = 0.737). A proportion meta-analysis using random-effect models was performed to estimate the pooled prevalence and the 95% confidence intervals (CI) using Der-Simonian and Laird weights. Heterogeneity among studies was assessed using the I 2 statistics.

Results

A total of 27 studies remained after qualitative analysis including 402,339 patients. The male/female ratio ranged from 1.5:1 to 3.5:1. Road traffic accidents corresponded to the main etiology agent of maxillofacial trauma (34%; 95% CI, 25–44), followed by falls (31%; 95% CI, 25–37), violence (11%; 95% CI, 4–19), sports (4%; 95% CI, 3–5), and others (5%; 95% CI, 2–8). Heterogeneity among studies was high, even stratifying by world region. The adapted version of the Newcastle-Ottawa scale for observational studies showed an intermediate score for most of the included studies.

Conclusions

Results suggest that road traffic accidents represent the main cause of maxillofacial trauma among children and adolescents. However, results should be interpreted with caution due to the high heterogeneity.
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12.

Background

Maxillofacial fractures occur in a significant proportion worldwide and can occur as an isolated injury or in combination with other severe injuries including cranial, spinal, and upper and lower body injuries requiring prompt diagnosis with possible emergency interventions. The epidemiology of facial fractures varies with regard to injury type, severity, and cause and depends on the population studied. Hence, understanding of these factors can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries.

Materials and methods

In this present retrospective study, we provide a comprehensive overview regarding cranio-maxillofacial trauma on 3611 patients to assist the clinician in assessment and management of this unique highly specialized area of traumatology. A preformed pro forma was used to analyze the medical records of patients treated for facial trauma in The Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai. The distribution according to age, gender, etiology, type of injury, time interval between accident and treatment, loss of consciousness, facial bones involved, pattern of fracture lines, treatment offered, and postoperative complications were recorded and evaluated.

Results

We inferred male patients sustained more injuries mostly in the third decade of age. Road traffic accidents were the most common cause of injury. Mandible was the most commonly fractured bone in the facial skeleton. Soft tissue injuries occurred more in road traffic accidents and upper lip was the commonest site of injury.

Conclusion

Our study provides insights into the epidemiology of facial injuries and associated factors and can be useful not only in developing prevention strategies but also for grading the existing legal regulations and also for framing a more effective treatment protocol.
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13.

Background

Submental flap is a useful aid in maxillofacial reconstruction. For intraoral usage the hairs in male patients will create some problems.

Materials and Methods

In a retrospective study, patients in whom submental flap had been used for reconstruction of orofacial region between 2007 and 2013, in the Mashhad University, Ghaem Hospital, were included. The ways in which the problem of hairs was solved in male patients were evaluated.

Results

There were 42 patients in whom submental flap was used for orofacial reconstruction. Sixty percent were males. Three ways had been used for management of intraoral hairs: radiotherapy (9 patients), second surgery (2 patients) and flap de-epithelialization (13 patients).

Conclusion

Deepithelialized variant of submental flap is the best option when submental flap is used for oral cavity reconstruction in male patients. Flap thickness, age, race and postoperative radiotherapy can have strong influence on this strategy.
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14.

Aims

Traumatic injuries remain a major cause of morbidity, mortality and economic loss worldwide. An audit of maxillofacial injuries presenting and managed at any facility is key to understanding the trends, strategies for prevention and improving outcome of care. We sought to study the pattern and treatment of facial bone fractures managed at the Department of Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospital, Ile-Ife, between 2005 and 2013. Also, to compare these with the pattern in the preceding 29 years.

Methods

Data on patients’ socio-demographics, dates of injury and presentation, interval before presentation, agent of injury, type of crash, patient’s status, type(s) of fracture, extent of injury, treatment offered and outcome were collected and analyzed.

Results

311 patients aged 5–72 years were reviewed. A male preponderance was observed. Peak age incidence was 21–30 years and 86.1 % of injuries resulted from road traffic crashes (RTC) most (67.5 %) of which were motorcycle related injuries. 215 patients sustained mandibular fractures in 311 sites while 141 patients sustained 225 midface fractures. Of the 242 patients managed definitively, only 11.2 % had open reduction and internal fixation.

Conclusion

Motorcycle related RTC remains the major cause of facial bone fractures. Management with osteosynthesis is gradually emerging, although demonstrating fewer complications, it is unaffordable for a majority.
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15.

Objective

To asses the fate of the costochondral graft (CCG) used to stimulate mandibular growth in the management of Temporomandibular joint (TMJ) reconsrtuction in ankylosis—histologically.

Materials and Methods

Ten patients who had undergone CCG grafting for TMJ ankylosis between 1994–2009 in the department of Oral & Maxillofacial Surgery, Tamil Nadu Govt Dental College and Hospital, Chennai and had come back with reankylosis, were surgically explored and the graft along with the ankylotic mass was excised and evaluated histologically. There is no documented human study and clinically it is not possible.

Results

Histological evaluation revealed the presence of osseous tissue, fibrous tissue and osteocytes but no evidence of any chondroid tissue.

Conclusion

Our study showing the absence of chondroid tissue raises the question on the rationale of CCG in TMJ reconstruction when other interpositional gap arthroplasty can achieve a disease free joint.
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16.

Aim

The aim of this clinical paper is to introduce a technique to plan for functional maxillofacial reconstructions.

Materials and Methods

Preoperative dental casts were made of the patient and mock surgery performed on the casts. A fibula analogue was then placed in an ideal functional reconstruction position. New dentures were fabricated on the fibula analogue and drill holes for the placement of implants were placed through the denture. This denture formed as a guide to position the fibula transplant during surgery.

Results

This technique was useful in producing functional and rehabilitative outcomes in cases of both maxillary and mandibular reconstructive surgeries.

Conclusion

The Jugaad technique—denture based inverse planning—is a cost effective method for planning and executing maxillofacial reconstructions using mock surgery on casts and interim dentures.
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17.

Objectives

The reconstruction of oral function in irradiated patients with craniofacial tumors is a significant challenge. The aim of this study was to detect long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton.

Materials and methods

From 2004 to 2011, 36 irradiated patients underwent oral function reconstruction using implant-supported prostheses. Bone augmentation was completed using vascularized bone grafts in 22 patients. Fourteen patients were treated by hyperbaric oxygen therapy (HBO). A total of 198 dental implants were used in jaw rehabilitation. After loading, implant success rates, biological and prosthetic complications, patient satisfaction, and psychological changes were recorded.

Results

Bone augmentation of the jaw was successful and vascularized grafts provided an additional vascular supply in compromised irradiated tissue. Rehabilitation was successful in all of the patients after loading. Thirty-eight dental implants failed, and 35 implants were removed. The success rate of the implants was 93.6 % for 10 years after loading. It was not a significant difference in implant success rate between the HBO group and the other groups. The prosthodontic maintenance results and complication rates showed that patients required intervention 0.19 times per year. All patients were satisfied with the oral restoration results.

Conclusion

The restoration of oral function in radiotherapy patients with tumor resection using implant-supported prostheses is a viable treatment option.

Clinical relevance

Either alone or in combination with HBO, dental implant-supported prostheses can be used an effective therapeutic approach for irradiated patients with oral function reconstruction.
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18.

Purpose

To ascertain the pattern, incidence, causes, age and sex distribution, types, condition and treatment of maxillofacial fractures and their interwoven relationship being practiced in Bhopal.

Materials and Methods

Retrospectively 3 year records of patients with maxillofacial fractures from 12 selected centres in Bhopal were reviewed. The following data were extracted from the medical records: age; gender; site of the fracture(s); other associated injury(ies); cause of the trauma and method of treatment(s).

Result

In 1268 patients, a total of 2613 fractures were found of which 44.58 % patients had mandibular fractures. Parasymphysis was the most common site of fracture overall. Most patients were in the 21–30 year old age group, and the male: female ratio was 3.3:1. Road traffic accident accounted for 858 cases (67.67 %). Head injury was the highest occurring associated injury. Open surgical modalities was the most employed treatment modality in 52.60 % of cases.

Conclusion

Preference for open surgical treatment along with increasing trend of supplemental intermaxillary fixation was found, which prompts us to check for the underlying reason behind this, which could be the increasing number of displaced and comminuted fracture cases or the decreasing efficiency of open reduction treatment rendered. Latter reason prompts to re-evaluate the existing surgical techniques and expertise of the practicing surgeons.
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19.

Background

Oral and maxillofacial radiology became the ninth dental specialty recognized by the American Dental Association (ADA) in 1999. This came about following the discovery of X-rays by Wilhelm Conrad Roentgen in 1895 and, 14 days later, the application of X-rays to making dental radiographs by Otto Walkhoff. The purpose of this narrative study was to review the evolution of oral and maxillofacial radiology as a dental specialty in the USA and its recognition as a program of training by the West African College of Surgeons.

Methods

This study was conceptualized as a narrative review of the literature focusing on the history and development of oral and maxillofacial radiology in the USA. It builds a synthesis that describes the recognition of oral and maxillofacial radiology as a specialty of dentistry in West Africa, UK, Japan, and Australia.

Results

The main finding was that oral and maxillofacial radiology became the ninth specialty recognized by the American Dental Association, ADA, in October 13, 1999. On March 20, 2014, the West African College of Surgeons recognized this specialty and granted accreditation for postgraduate training. In the UK, Japan, and Australia, the postgraduate education in oral and maxillofacial radiology has two patterns, namely professional training and academic training.

Conclusions

The primary goal of the postgraduate training curriculum is to train radiologists who are competent to deliver care to patients in any clinical setting, including a dental school, hospital radiology practice, or private practice.
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20.

Aim

The present study was planned to investigate the etiology of injuries and to analyze correlation between clinical and radiological findings in cases of craniomaxillofacial trauma.

Study Design

An 18 months cross-sectional study was done and 325 patients with maxillofacial fractures were analyzed from January 2013 to June 2014 who reported to the department of oral and maxillofacial surgery, Aligarh, Uttar Pradesh. Data was recorded in a preformed case sheet which included: patient’s demographic data, cause of injury, type of injury, treatment plan.

Results

Out of the 325 patients, 74.4 % were males with a male: female ratio of 2.91:1. The 21–30 year age group was found to be maximum. Road traffic accidents accounted for 71.3 %, followed by fall from height (19 %) and assault (9.5 %). Most commonly involved vehicles were two wheelers followed by public transport. Mandibular fractures (65 %) were most prevalent, followed by zygomaticomaxillary complex (44.27 %), parietal bone (48 %) and orbital fractures (21.3 %). Thirty-seven fractures (7.14 %) were missed clinically which were confirmed later by radiographic technique. Maximum were in cranium region (57 %) followed by mandible (27 %), mid face region (16.21 %). Thirty-three fractures (6.37 %) were overestimated or suspected clinically which could not be confirmed by radiographic technique. Maximum were in mandible (48.5 %) followed by mid face (36.33 %) and cranium (15.15 %).

Conclusion

The idea behind this article is to analyze the various trends and affecting factors and correlation between clinical and radiological findings. A better understanding of the above said would help in future treatment planning and management of facial injuries.
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