3
J Gandhara Med Dent Sci
April - June 2025
ORIGINAL ARTICLE
:
:
FREQUENCY OF MAXI
LLOFACIAL TRAUMA IN PATIENTS REPORTING TO ORAL AND
MAXILLOFACIAL SURGERY UNIT, LADY READING HOSPITAL, PESHAWAR
Maryam Gul
1
,
Hina Afsar
2
,
Ayesha Zahoor
3
,
Mashaal Naeem
4
,
Numan Khan
5
ABSTRACT
OBJECTIVES
This study
aimed
to determine the epidemiology and primary
etiology
of
maxillofacial fractures and to correlate these factors to identify the main
patient categories affected by various traumatic etiologies.
METHODOLOGY
This cross
-
sectional study was conducted at the Department of Oral and
Maxillofacial Surgery,
Lady Reading Hospital, Peshawar, Pakistan, from 21
July 2023 to 30 April 2024.
Ethical approval was obtained from the
Institutional Review Board, and informed consent was acquired from all
participants. Patients of all ages and
sexes who presented
with ma
xillofacial
trauma were included.
The data
were collected using a structured
questionnaire and clinical examination,
and the analyses were
performed
using R statistical software.
RESULTS
A total of 137 patients were included, with a
greater
prevalence of
maxillofacial fractures among males (68.61%) and individuals aged 18
-
30
(67.88%). Road traffic accidents were the most common cause of injury
(35.04%).
F
emales were more likely to be involved in assaults (
χ
² = 18.614, p
= 0.00033). The chi
-
square tests and
one
-
way ANOVA showed no significant
differences in BMI, duration of complaints, or age based on the laceration
site or mechanism of injury.
CONCLUSION
This study highlights the high incidence of maxillofacial fractures among
young adults, primarily due t
o road traffic accidents and interpersonal
violence. The findings underscore the need for preventive strategies, better
traffic regulations, and targeted education to reduce the incidence of these
injuries.
KEYWORDS:
F
acial Fractures
,
Epidemiology,
Interpersonal Violence,
M
axillofacial
Trauma, Road Traffic Accidents
How to cite this article
Gul M, Afsar H, Zahoor A, Naeem M,
Khan N
.
Frequency
o
f Maxillo
facial
Trauma
i
n Patients Reporting
t
o Oral
a
nd Maxillofacial Surgery Unit, Lady
Reading Hospital, Peshawar
.
J Gandhara
Med Dent Sci. 2025;12(2):3-8.
https://
doi.org/10.37762/jgmds.12-2.653
Date of Submission:
30
-
11
-
2024
Date Revised:
26
-
01
-
202
5
Date
Acceptance:
09
-
03
-
202
5
1
Resident
,
Department of Oral and
Maxillofacial Surgery, Lady Reading
Hospital, Peshawar, Pakistan
2
Specialist Registrar
,
Department of
Oral and Maxillofacial Surgery, Lady
Reading Hospital, Peshawar, Pakistan
3
Resident
,
Department of
O
ral and
M
axillofacial
S
urgery Lady
R
eading
H
ospital
P
eshawar
P
akistan
4
Resident
,
Department of
O
ral and
M
axillofacial
S
urgery Lady
R
eading
H
ospital
P
eshawar
P
akistan
Correspondence
5
Nu
man
K
han
,
Resident
,
Department
of
O
ral and
M
axillofacial
S
urgery
Lady
R
eading
H
ospital
P
eshawar
P
akistan
+92
-
316
-
2929922
maliknumank4@gmail.com
INTRODUCTION
Facial trauma is
becoming
increasingly prevalent
globally, representing the most common pathology
diagnosed and treated in oral and maxillofacial surgery
departments.
1
Trauma
is the primary cause of
maxillofacial injuries
and affects
skeletal components,
dentition, and soft tissues of the face due to impacts on
the maxillofacial region.
2
The frequency and severity of
maxillofacial injuries are
increasing due
to the heavy
relia
nce on road transportation and the growing
socioeconomic
activities of populations.
3
Over the past
three decades, the
etiology
of maxillofacial trauma has
evolved continuously, varying by socioeconomic status,
cultural characteristics, geographical locatio
n, and age
group.
4
Maxillofacial trauma
has
a multifactorial
etiology
, including road traffic accidents (RTAs),
accidental falls, assaults, industrial mishaps, sports
injuries, and firearm injuries (FAIs).
5
The severity and
pattern of maxillofacial trauma depend on the
anatomical site of injury, the force magnitude, and the
direction of the impact.
6
Historically, the pattern of
maxillofacial trauma was
more straightforward
. Facial
trauma, based on
the etiolo
gy
and injury mechanism,
can range from superficial lacerations and abrasions to
facial bone fractures and may occur alongside systemic
injuries such as
in the
head, cervical spine, chest,
abdomen, and extremities, necessitating a
multidisciplinary approac
h for management
.
7
Injuries
can occur in isolation or as part of polytrauma,
coexisting with intracranial, cerebral, ocular, spinal,
thoracic, or abdominal injuries, significantly increasing
case complexity and morbidity
.
8
Alterations to facial
features ca
n result in functional, psychological, social,
and professional consequences that are difficult to
reverse over time. Consequently, managing
maxillofacial fractures is complex, often requiring a
multidisciplinary approach and incurring high costs
.
9
Prevent
ion of maxillofacial fractures directly enhances
public oral health, given the associated challenges such
4
J Gandhara Med Dent Sci
April - June 2025
as infections or osteitis from fracture site exposure and
dento
-
periodontal trauma necessitating costly secondary
oral rehabilitation.
Current studies
in the local
population predominantly focus on bony fractures, with
limited data on the patterns and
etiology
of
maxillofacial trauma
, including
soft tissue injuries and
nerve injuries, which are often overlooked. This study
aimed
to determine the epidemi
ology and primary
etiology
of maxillofacial fractures, correlate these
factors to identify the main patient categories affected
by various traumatic etiologies and examine the
frequency and predictors of soft tissue and
brutal
tissue
injuries
.
METHODOLOGY
This cross
-
sectional study was conducted at the
Department of Oral and Maxillofacial Surgery, La
dy
Reading Hospital, Peshawar, Pakistan.
The study
spanned ten months
from 21 July 2023 to 30 April
2024.
Patients
with ages from 18 to 40 years were
included in the study,
who presented
with maxillofacial
trauma involving skeletal components, dentition, a
nd/or
soft tissues of the maxillofacial region were included in
the study.
Patients with isolated dental injuries without
associated maxillofacial trauma and those who refused
to provide informed consent were excluded.
The sample
size was determined based
on the prevalence of
maxillofacial trauma
patients who
presented to the
department during the study period.
One hundred thirty
-
seven
patients
who
met the inclusion criteria were
enrolled in the study.
Patients
who presented
with
maxillofacial trauma were e
valuated and managed
according to the department’s standard clinical
protocols.
The data
were collected systematically using
a structured questionnaire and clinical examination.
The
demographic
information collected included age,
sex
,
and residential statu
s (urban/rural).
The injury
characteristics recorded
included
the mechanism of
injury (road traffic accident, fall, assault, other), time of
injury, location of injury occurrence (home, workplace,
public place,
different
), presence of polytrauma
(yes/no),
and duration of complaints (hours from injury
to presentation). Clinical findings included the type of
injury, specific injury site, presence of peripheral nerve
involvement (yes/no), and initial management and
treatment provided.
Informed consent was obta
ined
from all participants or their legal guardians (for
minors) before inclusion in the study. Participants were
informed about the study's purpose, procedures,
potential risks, and benefits. Confidentiality and
anonymity were ensured throughout the study
.
All
patients underwent a thorough clinical examination by
experienced oral and maxillofacial surgeons. The
examination included inspection and palpation of the
maxillofacial region to identify fractures, lacerations,
and other injuries
;
a neurological ex
amination to assess
peripheral nerve involvement; and a
radiographic
evaluation using X
-
rays, CT scans, or MRI as indicated
to confirm and detail the extent of skeletal injuries.
The
data
were entered into a computerised database and
analysed using R stati
stical software. Descriptive
statistics were used to
summarise
demographic
information and injury characteristics. Continuous
variables
are
presented as
the
mean ± standard
deviation (SD), and categorical variables
are presented
as frequencies and percenta
ges. Inferential statistics
included a
chi
-
square test
to assess the association
between categorical variables (e.g.,
sex
and mechanism
of injury, age group, and laceration site)
and logistic
regression analysis
to identify predictors of specific
types of
injuries, adjusting for potential confounders.
Independent
t
-
tests
were used
to compare continuous
variables (e.g., BMI, duration of complaints) between
different groups (e.g., males vs. females, age groups).
A
p
-
value less than 0.05 was considered
statist
ically
significant.
Ethical approval was obtained from the
Institutional Review Board (IRB) of
Lady Reading
Hospital, Medical Teaching Hospital
(Approval No.
[
239/LRH/MTI
]). Informed consent was obtained from
all participants before their inclusion in the
study,
ensuring adherence to the ethical guidelines stipulated
by the Declaration of Helsinki.
RESULTS
Most participants were male (68.61%) and lived in
urban areas (55.47%). Most participants were between
18 and 30 years old (67.88%). The most common type
of injury reported was road traffic accidents (35.04%).
Peripheral nerve involvement was absent in 67.88% of
patients, and 45.99% had no laceration.
The average
age of
the
participants
was
27.91
years
, with an SD of
5.95. The mean BMI
was
26.52, with an S
D of 3.01.
Table
1
: Chi
-
Square Test
of
Independence
for
Gender
and
Various Factors
V
ariable
Detail
Male
Female
P
V
alue
Site of
Laceration
Cheek
0
5
12
(
χ
²): 0.614
P= 0.961
Forehead
0
7
13
Infraorbital Region
0
4
10
Lower Lip and Chin
0
6
17
No Lac
eration
42
21
Mechanism
of Injury
Assault
0
1
16
(
χ
²):
18.614
P= 0.00033
Fall
0
7
02
Other
0
8
0
9
Road Traffic
Accident
0
6
25
Peripheral
Nerve
Injury
Yes
34
10
(
χ
²): 1.704
P value:
0.192
No
60
33
Frequency of Maxillofacial Trauma in Patients Reporting
5
J Gandhara Med Dent Sci
April - June 2025
Table
2
: Association between
Age Group and Var
ious Factors
V
ariable
Detail
18
-
30
Years
31
-
40
Years
P-Value
Site of
Laceration
Cheek
13
0
4
(
χ
²): 3.155
P= 0.532
Forehead
39
24
Infraorbital Region
12
0
8
Lower Lip and Chin
0
9
0
5
No Laceration
19
0
4
Mechanism
of Injury
Assault
21
0
9
(
χ
²): 2.
174
P= 0.537
Fall
11
0
7
Other
19
12
Road Traffic
Accident
32
16
Peripheral
Nerve
Injury
Yes
30
14
(
χ
²): 0.409
P value:
0.523
No
63
29
Table
3
: Chi
-
Square Test of Independence for Residential Status
and Various Factors
V
ariable
Detail
Rur
al
Urban
P-Value
Site of
Laceration
Cheek
0
9
12
(
χ
²): 7.942
P= 0.094
Forehead
28
35
Infraorbital Region
0
7
14
Lower Lip and Chin
0
8
0
5
No Laceration
0
8
15
Mechanism
of Injury
Assault
13
17
(
χ
²): 3.727
P= 0.292
Fall
13
0
5
Other
13
28
Road Traffic
Accident
22
26
Peripheral
Nerve
Injury
Yes
20
24
(
χ
²): 0.000
P value:
1.000
No
41
52
Table
4
:
ANOVA Analysis of Periodontal Parameters and
Microbiological Profile
Source
SS
df
MS
F
P
Site of
Laceration
& Duration
of
Complaints
Site of
Laceration
37.59
0
4
9.40
0.51
0.73
Residual
2452.81
132
18.58
Site of
Laceration
and BMI
Site of
Laceration
52.68
0
4
13.17
1.47
0.21
Residual
1179.08
132
8.93
Site of
Laceration
and Age
Site of
Laceration
37.04
0
4
9.26
0.26
0.91
Res
idual
4775.91
132
36.19
Mechanism
of Injury &
Duration of
Complaints
Mechanism
of Injury
40.59
0
3
13.53
0.73
0.53
Residual
2449.81
133
18.42
Mechanism
of Injury &
BMI
Mechanism
of Injury
36.20
0
3
12.07
1.34
0.26
Residual
1195.56
133
8.99
Mecha
nism
of Injury &
Age
Mechanism
of Injury
113.06
0
3
37.69
1.07
0.37
Residual
4699.89
133
35.34
SS (Sum of Squares): Represents the variability, df
(Degrees of Freedom): Number of levels in the factor,
MS (Mean Square): SS divided by df, F: Test statist
ic.,
p: Significance level
.
Table
5
: Tukey
’
s HSD Post
Hoc Test for Mechanism of Injury
and Site of Laceration on Various Factors
Group 1
Group 2
Mean
Diff
P
-
adj
Lower
Upper
Mechanism
of Injury
and BMI
Assault
Fall
-
0.63
0.7279
-
2.03
0.77
Ass
ault
Other
0.02
0.9998
-
0.90
0.94
Assault
Road
traffic
accidents
0.29
0.8991
-
0.58
1.17
Fall
Other
0.65
0.7166
-
0.72
2.01
Fall
Road
traffic
accidents
0.92
0.5055
-
0.32
2.16
Other
Road
traffic
accidents
0.27
0.9047
-
0.57
1.11
Mechanisms
of Injury
a
nd
Duration of
Complaints
Assault
Fall
-
1.27
0.7486
-
6.34
3.79
Assault
Other
-
0.91
0.8267
-
4.18
2.37
Assault
Road
traffic
accidents
-
1.89
0.3999
-
4.98
1.19
Fall
Other
0.36
0.9872
-
4.47
5.20
Fall
Road
traffic
accidents
-
0.62
0.9471
-
5.36
4.12
Othe
r
Road
traffic
accidents
-
0.99
0.7808
-
4.18
2.20
Mechanism
of Injury
and Age
Assault
Fall
3.67
0.6182
-
3.32
10.66
Assault
Other
1.21
0.8793
-
3.87
6.29
Assault
Road
traffic
accidents
2.06
0.8052
-
2.39
6.51
Fall
Other
-
2.45
0.8131
-
9.59
4.69
Fall
Ro
ad
traffic
accidents
-
1.61
0.9152
-
8.53
5.32
Other
Road
traffic
accidents
0.84
0.9648
-
3.30
5.09
Site of
Laceration
and BMI
Cheek
Forehead
-
0.51
0.8957
-
2.27
1.25
Cheek
Infraorbital
region
-
0.56
0.8877
-
2.46
1.33
Cheek
Lower lip
& chin
-
0.47
0.9362
-
2.55
1.61
Cheek
No
laceration
-
0.73
0.7813
-
2.25
0.80
Forehead
Infraorbital
region
-
0.05
0.9999
-
1.59
1.49
Forehead
Lower lip
& chin
0.04
1.0
-
1.79
1.88
Forehead
No
laceration
-
0.22
0.9891
-
1.40
0.97
Infraorbi
tal region
Lower lip
& chin
0.09
0.9
998
-
1.75
1.92
Infraorbi
tal region
No
laceration
-
0.17
0.9950
-
1.60
1.26
Lower lip
& chin
No
laceration
-
0.26
0.9831
-
1.83
1.30
Site of
Laceration
and
Duration of
Complaints
Cheek
Forehead
0.22
0.9999
-
8.10
8.54
Cheek
Infraorbital
region
-
1.83
0.976
0
-
11.20
7.54
Cheek
Lower lip
& chin
-
2.17
0.9582
-
12.64
8.31
Frequency of Maxillofacial Trauma in Patients Reporting
6
J Gandhara Med Dent Sci
April - June 2025
Cheek
No
laceration
-
0.63
0.9999
-
8.02
6.76
Forehead
Infraorbital
region
-
2.04
0.9682
-
11.56
7.48
Forehead
Lower lip
& chin
-
2.39
0.9482
-
13.00
8.22
Forehead
No
laceration
-
0.85
0.9998
-
8.21
6.51
Site of
Laceration
and Age
Infraorbi
tal region
Lower lip
& chin
-
0.35
0.9999
-
11.68
Infraorbi
tal region
No
laceration
1.19
0.9974
-
7.57
Lower lip
& chin
No
laceration
1.54
0.9931
-
7.98
Cheek
Forehead
-1.51
0.9347
-
8.28
Cheek
Infraorbital
region
0.15
1.0
-
7.30
Cheek
Lower lip
& chin
-
1.14
0.9791
-
8.77
Cheek
No
laceration
0.37
0.9999
-
5.37
Forehead
Infraorbital
region
1.66
0.9178
-
6.42
Forehead
Lower lip
& chin
0.37
0.9999
-
8.70
For
ehead
No
laceration
1.88
0.8643
-
4.12
Infraorbi
tal region
Lower lip
& chin
-
1.28
0.9636
-
8.95
Infraorbi
tal region
No
laceration
0.22
1.0
-
6.15
Lower lip
& chin
No
laceration
1.51
0.9347
-
5.42
10.97
9.94
11.06
5
.26
7.60
6.48
6.10
9.74
9.44
7.88
6.38
6.58
8.44
Table 6: Independent T
-
Tests
for
Gend
er
a
nd Age Group
o
n B
MI
f Complaints
a
nd Duration
o
Gender
Mean
BMI
SD
BMI
t
df
p
Gender
and BMI
Male
22.98
2.34
-
1.47
135
0.145
Female
23.58
2.69
Gender
and
Duration of
Complaints
Male
55.95
4.25
0.05
135
0.960
Female
55.91
4.40
Age group
and
BMI
18 to 30
years
26.35
3.09
-
0.98
135
0.327
31 to 40
years
26.89
2.84
Age Group
and
Duration of
Complaints
18 to 30
years
55.31
4.10
-
2.52
135
0.013
31 to 40
years
57.25
4.40
SE: Standard Error, t: t value (Test Statistic), p:
p
-
value
DISCUSSION
This research
revealed
a high incidence of maxillofacial
fractures among individuals aged 18
-
30, which aligns
with previous findings. Our data show that 67.88% of
participants
were
within the 18
-
30 age range, with road
traffic accidents being the m
ost common cause of injury
(35.04%). This age group is notably more socially,
professionally, and physically active, making them
more prone to trauma.
10
Increased
participation in
social events, often involving alcohol or recreational
drug use, heightens t
he risk of interpersonal conflicts
leading to physical aggression.
11
Additionally,
inexperience,
noncompliance
with traffic rules, and
high
-
speed driving further contribute to this
demographic
’
s elevated risk of road traffic accidents.
12
In contrast
to our
findings, other studies
have reported a
greater
incidence of maxillofacial fractures in the 30
-
to
39
-
year
-
old
age group, possibly due to global
population
aging
.
13
Our study
demonstrated a greater
prevalence of maxillofacial fractures among males
(68.61%
), consistent with
the
literature. Behavioural
tendencies in males to engage in interpersonal conflicts
and their frequent involvement in physical labour and
extreme sports account for the
greater
fracture risk
in
males than in
females.
14
In urban areas, w
here 55.47%
of our participants reside, high population density,
social class disparities, and easy access to alcohol and
narcotics
increase
the risk of interpersonal conflicts and
road traffic accidents.
15
However, some studies suggest
a
greater
frequency
of fractures in rural areas,
attributable to regional differences in healthcare
institutions
.
16
This study also
revealed
a unique pattern
of increased interpersonal violence across both urban
and rural areas, a finding that is relatively uncommon in
the
l
iterature
.
17
Our findings indicate that
67.88% of the
most affected patients
had
no peripheral nerve
involvement, and 45.99%
had
no laceration. Lower
social status and limited access to healthcare can lead to
frustration, depression, and increased vulnerab
ility to
interpersonal violence
.
18
Interpersonal violence was the
predominant cause of maxillofacial fractures, consistent
with studies from various regions
,
including Germany,
Brazil, the USA, Italy, Australia, Norway, and
Sweden.
19
Developed countries ha
ve seen a rise in
interpersonal violence as the primary etiological factor,
overshadowing road traffic accidents and sports
injuries. This trend is linked to the cultural and social
dynamics in urban environments and the interplay
between alcohol consumpti
on and violence.
20
In
contrast, regions
such as
Nigeria, Uganda, India, Egypt,
Saudi Arabia, China, South Korea, Malaysia, and Iran
have reported
higher incidences of fractures due to road
traffic accidents,
which are
driven by inadequate traffic
regulatio
ns and infrastructure.
11
Effective traffic rules
and stringent penalties have contributed to a reduction
in traffic
-
related fractures in our country. Other studies
have highlighted
falls as a primary cause of fractures,
particularly in regions with effecti
ve violence and
accident prevention measures and among elderly
people
, who are more prone to fall
-
induced facial
trauma.
21
Work
-
related, domestic, and animal attack
-
induced maxillofacial fractures were less common and
more prevalent in rural areas, consist
ent with
the
literature
.
22
The mandible
is
the most frequently
Frequency of Maxillofacial Trauma in Patients Reporting
7
J Gandhara Med Dent Sci
April - June 2025
fractured bone
,
owing to its prominence and
vulnerability to trauma
.
23
Discrepancies in the reported
locations of mandibular fractures reflect the variability
in trauma mechanisms and condition
s at the time of
impact. The zygomatic bone
is
the most fractured in the
midface due to its structural and biomechanical
properties
.
24,25
This study provides vital insights into
the
etiology
and epidemiology of maxillofacial
fractures, guiding resource all
ocation in healthcare,
training for medical personnel, and implementing
preventive measures.
However, the retrospective nature
of this study
poses limitations, such as potential
inaccuracies in patient records and intentional
misreporting of causes
of trau
ma
, particularly in cases
of interpersonal aggression. Future
randomised
controlled trials are recommended to address these
shortcomings.
LIMITATIONS
The study contributes much t
o the current literature
but
has a limited sample size and is single
-
centered.
CONCLUSIONS
This study highlights the significant incidence of
maxillofacial fractures, particularly among young adults
aged 18
-
30 years,
which are
primarily caused by road
traffic accidents and interpersonal violence.
Education
is a crucial preventive measure, with higher educational
levels correlating with fewer trauma incidents.
CONFLICT OF INTEREST:
None
FUNDING SOURCES:
None
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4.
Mashaal Naee
m
-
Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Supervision; Final Approval
5
.
Numan Khan
-
Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revis
ion; Supervision; Final Approval
CONTRIBUTORS
1.
Maryam Gul
-
Concept & Design; Data Acquisition
; Data
Analysis/Interpretation; Drafting Manuscript;
Critical
Revision; Supervision
2.
Hina Afsar
-
Concept & Design; Data Acquisiti
on; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Supervision; Final Approval
3.
Ayesha Zahoor
-
Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Supervision