Abosadegh, Maher Mahmoud Ahmed Ali
(2018)
Association of traumatic head injuries and maxillofacial fractures among patients treated at Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: The association of traumatic head injury (THI) with
maxillofacial fractures (MFF) is major health concern worldwide. In spite of the
close anatomical proximity of maxillofacial bones to the cranium, the association of
THI with MFF is remained controversial as the patients with MFF are at high risk to
sustain THI simultaneously. In such cases, recognition of the pattern of that
association is an important information during initial assessment and treatment
planning to reduce morbidity and mortality therefore improve the outcome of
treatment. Objectives: This study assesses the association between THI and MFF
among patients treated by Oral & Maxillofacial Surgery Unit and determine its
prevalence. In addition, the other factors associated with THI in patients with MFF
(age, sex, etiological causes, and types of MFF) and the Glasgow coma scale (GCS)
score for those patients were also investigated. Materials and methods: A hospitalbased
retrospective study at Hospital Universiti Sains Malaysia, Malaysia from June
12, 2013, to December 31, 2015 was conducted. A total of 473 patient records with
MFF were reviewed in this study to evaluate the association of THI and MFF. The
factors associated with THI were determined at both univariable and multivariable by
using simple and multiple logistic regression analysis respectively to achieve that
aim. The chi-square test was used for determining the association of GCS score.
Results: Prevalence of THI among the patients with MFF was 69.98%. Cranial bonefractures (68.6%) being commonest of THI followed by intracranial injuries and
concussion. Orbital wall fracture was the most frequent amongst patients with THI
(61.0%), followed by fractures of maxillary sinus wall (36.9%), nasal bone (30.5%),
and mandible bone (25.4%). A significant association exists between the GCS score
and THI accompanying MFF with almost half of the patients (55.0%) had a mild
head injury (GCS score 13-15). Motorcycle accident (MCA) was the most common
cause of injury (75.8%), followed by motor vehicle accident (MVA) (10.9%) and fall
(4.5%). The aetiology road traffic accident (RTA) and types of MFF (nasal bone,
zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and
mandibular alveolar process) were statistically significantly associated with THI in
patients with MFF [Adjusted odds ratio (AOR) = 4.65, 2.13, 2.37, 2.77, 3.38, 2.05,
and 0.48 respectively]. Conclusion: A high prevalence of THI among patients with
MFF (69.98%) considered as one of the highest percentagesworldwide. Although the
majority of patients sustained mild head injuries of GCS score (13-15), the chance of
THI still strongly suspected in those patients independent of GCS scores. Nasal bone,
zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and
mandibular alveolar process fractures representing types of MFF which found
statistically significant associated with THI in the patient sustained MFF while
among the etiologies of injury only RTA was found statistically significant
associated with THI.
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