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FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
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FACE FRACTURES AETHIOLOGY AND INCIDENCES
IN THE SURGERY AND TRAUMATOLOGY
MAXILLOFACIAL SERVICE BASE HOSPITAL
BAURU - SÃO PAULO – BRAZIL
ETIOLOGIA E INCIDÊNCIA DAS FRATURAS FACIAIS
NO SERVIÇO DE CIRURGIA E TRAUMATOLOGIA
BUCOMAXILOFACIAL DO HOSPITAL DE BASE DE
BAURU – SÃO PAULO – BRASIL *
Nelson PEREIRA MARQUES **
Clóvis MARZOLA ***
Cláudio Maldonado PASTORI ****
João Lopes TOLEDO FILHO *****
Daniel Luiz Gaertner ZORZETTO *****
Marcos Maurício CAPELARI *****
Gustavo Lopes TOLEDO *****
* Research presented as a partial requirement of the Discipline of Teaching Methodology
and Research to obtain a course completion certificate of Oral and Maxillofacial
Surgery Residency sponsored by the Foundation for Medical and Hospital
Development (FAMESP). Discipline head professor: Prof. Dr. Clóvis Marzola.
** Dentist Surgeon conclusive of Residency Program in Surgery and Maxillofacial sponsored
by the Brazilian College of Oral and Maxillofacial Surgery and Bauru Base
Hospital.
*** Retired Surgery Head Professor of FOB-USP. Founder and full member of Brazilian
College of Oral and Maxillofacial Surgery. Full member of the Odontology Brazilian
Academy and Tiradentes Academy of Odontology. President of Tiradentes
Academy of Odontology.
**** Professor of Surgery and Traumatology Oral Maxillofacial sponsored by the Brazilian
College of Oral and Maxillofacial Surgery and Bauru Base Hospital. Master and
Doctor degree in Surgery and thesis advisor.
***** Professors of Oral and Maxillofacial Surgery course sponsored by the Brazilian College
of Oral and Maxillofacial Surgery and Base Hospital of Bauru.
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
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FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
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ABSTRACT
Facial trauma has increased incidence in the last four decades,
primarily due to the increase of traffic accidents and urban violence, which
remain the main causes of these traumas. The purpose of this paper is to
analyze the frequency, incidence and aethiology of face fracture, in the
Surgery and Traumatology Service Base Hospital Bauru, between March
2012 and March 2013. During this time, it was observed that nasal bone was
the most commonly structure fractured, followed by the inferior jaw and
zygomatic bone.
RESUMO
O trauma facial apresenta incidência crescente nas últimas
quatro décadas, principalmente devido ao aumento do número de acidentes
automobilísticos e da violência urbana, sendo estas as principais causas de
traumatismos em indivíduos jovens. O propósito deste trabalho é analisar a
frequência, incidência e etiologia das fraturas de face no Serviço de Cirurgia
e Traumatologia Bucomaxilofacial do Hospital de Base de Bauru entre março
de 2012 e março de 2013. No período avaliado, observou-se que o osso
nasal foi à estrutura mais comumente fraturada, seguida da mandíbula e
osso zigomático.
Uniterms: Facial Injuries; Face; Fractures, Bone.
Unitermos: Traumatismos Faciais; Face; Fraturas Ósseas.
INTRODUCTION
The facial trauma is daily observed in emergency hospitals. It
affects mostly the younger part of the population and the main causes of
these traumas are traffic accidents and physical aggression. The detailed
study of the facial trauma epidemiology has importance to let patients be
submitted to the most appropriate treatment. The incidence evaluation and
the facial fractures aethiology, allows a more accurate and appropriate
treatment consequently (MARZOLA, 2008 and MARQUES; GUEDES;
SIZENANDO, 2010).
Bauru Base Hospital, São Paulo, Brazil is reference on Surgery
and Traumatology Oral Maxillofacial. This study was realized on the period
of March 1st, 2012 to March 1st, 2013, period when was researched 80
medical records of patients with facial fractures and some of them with more
than one fracture (MARZOLA; TOLEDO-FILHO; SÁNCHEZ-TORO, 2005
and MARZOLA, 2008).
The nose is a central structure of the midline facial filling
functional and aesthetic requirements. Aesthetically helps building the facial
structure, being extremely relevant in the face symmetry. Functionally works
as a gateway to nasal breathing, the normal state for humans. Anatomically,
the nose is formed by the rigid bony structures union and flexible cartilage
structures (FONSECA; WALKER, 2001 and MARZOLA, 2008).
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
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By its central position and projection on the face, the nose is
often hittening on facial trauma, being fractured easily due to the thin bones
structure that constitutes it (ROCHA; MANGANELLO-SOUZA, 2006 and
MARZOLA, 2008).
The facial fractures are classified with inferolateral
displacement, separation of the nasal bones in the midline, the frontal
apophysis jaw, open book fracture type and posterior inferior displacement.
Also, nasal septum fracture separating the maxilla bones and frontal
apophysis, with the dorsum of the nose nasal crushing. Septum fractures
may occur in the vertical plane can present pileup or juxtaposition
(DINGMAN; NATIVIG, 1983 and MARZOLA, 2008).
After 1492 patients analysis over a five years period, a total of
1598 facial fractures were related, being nasal fractures observed in 775
cases (48.49%), followed by 483 cases (30.22%) of zygomatic-maxillary
fractures. The patients age range seen ranged from 1 to 99 years, being the
most affected those individuals between the second and third decade of life.
The main aethiology of facial fractures was observed on physical aggression,
represented by 482 fractures cases (30.16%), followed by accidental falls
with 357 cases (22.34%) (REIS; MARZOLA; TOLEDO FILHO, 2001 and
MARZOLA, 2008). The patient with this type of fracture often presents
unilateral or bilateral epistaxis, mobility and crepitus bony deviations and
sags bone, nasal septum deviation, ecchymosis or hematoma in the septum,
periorbital ecchymosis, subconjunctival ecchymosis, and enlargement of the
nasal dorsum. The treatment of isolated fractures is usually done by closed
reducing bone via nostrils (ARAÚJO; GABRIELLI; MEDEIROS, 2007).
There is no uniform protocol for nasal fractures manipulation,
being several approaches reported as a reducing manual. The manual
reduction associated with forceps, only performed with forceps, septoplasty
associated and even rhinoplasty are also noted.
The nasal bones
manipulation may be practiced without general anesthesia, using only local
anesthesia or under general anesthesia (KAPOOR; RICHARDS;
DHANASEKAR et al., 2002). The conduct regarding nasal fractures follows
the general principles of the injuries treatment, with reduction in fractured
fragments replacement in the anatomical position further the consolidation
during the immobilization period. Nasal fractures or portion of the bony
framework or septum, if not properly treated, can determine important
functional disturbances in respiratory physiology. Thus, adequate correction
of nasal fractures is not limited in resolution only of cosmetic deformity but
mostly to restore respiratory function (ROCHA; MANGANELLO-SOUZA,
2006).
The mandible is the structure with the highest fracture incidence
in facial trauma case. Automobile motorcycle and cycling accidents are
considered as major etiologic agents of mandibular fractures. Legal and
educational measures have great importance for the facial trauma
prevention, should be established with all the rigors, emphasizing the use of
seat belt, helmet, respect to the speed limits and awareness of alcohol /
direction binomial. The Brazilian Law (Lei Seca) came to act as a preventive
measure for the society to punish offenders (MARZOLA, 2008 and
NORONHA FILHO; VALENTE; KOSLOWSKY, 2012).
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
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FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
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The physical aggression was the most frequent aethiology
involving 27.9% of cases diverging from this study that appeared as the main
aethiology auto accidents (MARZOLA; TOLEDO-FILHO; SÁNCHEZ-TORO,
2005 and MARZOLA, 2008). The most common etiologic agent was
automobile accidents, a total of 26.67%. Summed over all the traffic
accidents, the total goes to 42.97% of the cases (SOUZA SILVA; TOLEDO
FILHO; MARZOLA et al., 2005 and MARZOLA, 2008). The nasal fractures
ranks first place in prevalence of facial fractures and the leading cause of
nasal fractures are the physical aggressions, followed by falls from standing
height and motor vehicle accidents (MARZOLA, 2008 and FERREIRA;
OLIVEIRA; MARZOLA, 2011). Regarding gender, most fractures occur in
male patients, on average 80% and only 20% in female patients (KRAUSE;
SILVA JUNIOR; SCHNEIDER et al., 2004 and MARZOLA, 2008). The
most affected gender was male (77.92%), aged between 21 and 30 years old
(31.17%) (MARZOLA, 2008 and DAL PONTE; ROSA; MARZOLA et al.,
2011).
From 251 mandibular fractures, 80% were males and only 20%
were females, aspect perfectly comparable with the vast majority of
researchers who also found this disproportion. One can accept this index
much higher by assigning greater exposure to male daily activities such as
heavy lifting; the largest numbers of drivers were male; the largest force in
sports more violent in addition to the greater predisposition to interpersonal
violence (MARZOLA; TOLEDO-FILHO; VILA-REAL and MARZOLA, 2008).
This research had the objective to evaluate the nasal fractures
prevalence in the Surgery and Traumatology Maxillofacial Service at the
Base Hospital of the Hospital Bauru Association, distributed according to
gender, age, aethiology, treatment modality, presence or absence of
associated fractures in addition to postoperative complications. Were
conducted an observational epidemiological, descriptive and retrospective
study of medical records of these cases of patients seen at the Department
of Oral and Maxillofacial Surgery of Bauru Base Hospital in the period
November 2009 to November 2010. The data were recorded on specific files
and tabulated. The research objective was to evaluate the prevalence of
nasal fractures distributed according to gender, age, aethiology, treatment
modality, and postoperative complications. The male gender was involved in
66.66% of cases and the age range in the 3rd decade of life. Physical
aggression was the aethiology most related and approximately 6.66% cases
were associated with zygomatic fracture. Surgical treatment was indicated in
70.76% of the cases being performed under general anesthesia with closed
fractures reduction in all surgical cases. The only complication observed was
the synechia, present in 8.20% of cases. Justifying this mode of research by
the ever more appreciation of statistical work in a Maxillofacial Service in
Brazil. This fact, in addition to its importance lies in the fact that through the
study statistician and the prevalence of nasal fractures, it becomes easier to
develop preventive rules preventing this injury type and possible
complications after treatment (FERREIRA; SOUZA DE OLIVEIRA;
CAPELARI; MARZOLA et al., 2011).
Fractures of the zygomatic-orbital are not necessarily high
intensity, but can cause serious complications due to their functional and
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
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FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
aesthetic characteristics, resulting in limitations to the individuals involved in
this type of injury. To evaluate the fractures of the zygomatic-orbital complex
prevalence in the city of Bauru were researched over a period of 2 years and
8 months (January 2006 to August 2008), 1355 files of patients that suffer
from some sort of trauma to the maxillofacial region facial, presenting 308
fractures of zygomatic-orbital complex. Based in the literature researched
and data obtained it was concluded that: 1. Zygomatic-orbital fractures ranks
third in prevalence of facial fractures, behind the nasal and mandibular 2. The
most affected gender was male (77.92%), aged between 21 and 30 years old
(31.17%) 3. The main aethiology was Physical aggression (27.92%), followed
by motorcycle (14.29%) and cycling accidents (12.34%) 4. The zygomaticorbital region with a higher fracture incidence was the body of the zygomatic
bone (67.8%). 5. Nasal bones fractures were more often associated with
those of the zygomatic-orbital (23.7%) 6. The most common treatment was
open fractures reduction and the realization of rigid internal fixation (57.6%),
and 7. In 96.4% of cases there were no complications, but when it occurred,
the most common was the infraorbital nerve paresthesia (2.2%) (DAL
PONTE; SILVA ROSA; ZORZETTO; MARZOLA et al., 2011).
Due to the high incidence of facial fractures in hospitals with
Oral and Maxillofacial Surgery Service, the objective of this study was to
describe the experience in attending these patients in the Bauru Base
Hospital, São Paulo, Brazil in the period 2012 to 2013 and set the patients
gender most affected, as well as the aethiology of fractures and the most
fractured.
MATERIAL AND METHODS
SAMPLING SELECTION
A search was conducted on patients records who had suffered
facial trauma, resulting on facial bones fracture. The data collection for this
study was made on the records of the Oral and Maxillofacial Surgery Clinic of
the Base Hospital in Bauru, São Paulo, Brazil, from March 2012 to 2013.
The Bauru Base Hospital is associated to the Foundation for Medical
Hospital Development (FAMESP), a reference on the Public Health System
(SUS) in the region. Performs care for patients with complex maxillofacial
treatment needs, among other specialties, acting historically training to form
maxillofacial surgeons. The sample was made with eighty subjects through
the Surgery and Traumatology Oral Maxillofacial clinic of the Bauru Base
Hospital, São Paulo, Brazil. Patients with one or more bone face fractures on
this period were included on the research. The ones that had facial trauma
but without fractures were not included on the research.
PROCEDURES FOR DATA COLLECTION
The data collection was made by just one examiner acting as a
researcher and note taker, so there was not diagnosis variation and data
interpretation. The sample components were noted by the researcher in a
database where was verified the patient gender, fracture type, trauma
aethiology and occurrence date (Table 1).
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
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FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
DATA ANALYSIS PROCEDURES
The data collected through interviews and clinical exams were
inserted in a database and analyzed and analyzed quantitatively and
percentage.
Table 1: Data collected on the records of Traumatology Oral Maxillofacial Clinic of the Bauru
Base Hospital.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Masculine Gender
64%
Feminine Gender
36%
RESULTS
According to the survey, it was observed that 64% patients
were male and 36% female (Table 2 and Chart 1).
Regarding facial fractures incidence in the male gender, it was
observed that 33% had nasal fractures, 27.7% jaw fractures, 31.5%
zygomatic bone fracture and panfacial fractures 7.5% (Table 3 and Chart 2).
Automobile accidents were considered the facial fractures aethiology of the
42.5% cases surveyed; 17.5% due to fall from own height; 35% due to
physical aggression; 1.25% due to attempted suicide and 3.75% due the ox
stepping (Chart 3).
The patients who presented nasal fractures, 21.4% had a car
crash as aethiology, 25% fall from own height and 53.6% physical aggression
(Chart 4). The patients with mandible fractures, 42.3% were automobile
accident result; a 19.2% fall from own height, 34.6% physical aggression and
3.9% suicide attempt (Chart 5). In zygomatic fractures cases, 66.6%
presented a car crash aethiology; 9.5% fall from own height; 14.4% physical
aggression and 9.5% were ox stepping victims (Figure 6). Panfacial
fractures had in 60% car crash aethiology, 20% physical aggression and
another 20% ox stepping (Chart 7).
Table 2 – Gender of the patients with facial fracture at the Surgery and Traumatology Oral
Maxillofacial Service of Bauru – SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Gender
M
M
M
Kind of fracture
Nasal
Jaw
Jaw
Aethiology
Physical agression
Car accident
Fall from own height
Trauma date
09/21/12
09/21/12
08/31/12
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
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FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
Chart 1 – Gender of the patients with facial fracture at the STOMF of Bauru – SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Gender of the patients with
facial fracture at the
Surgery and Traumatology Oral
Maxillofacial Clinic in Bauru – SP.
80%
Gender of the patients
with facial fracture at
the
Surgery and
Traumatology Oral
Maxillofacial Clinic in
Bauru – SP.
60%
40%
20%
0%
Masculine gender Feminine gender
Table 3 – Fractures incidence according to gender on the STOMF of Bauru–SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Fractures
Masculine gender
Feminine gender
Nasal
33,3%
38,4%
Jaw
27,7%
42,3%
Zygoma
31,5%
15,3%
Panfacial
7,5%
4%
Chart 2 – Fractures incidence on the STOMF of Bauru–SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
40%
Fractures incidence on the
Surgery and Traumatology
Oral Maxillofacial Service of
Bauru – SP.
30%
20%
10%
0%
Nasal
Jaw ZygomaPanfacial
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
166
FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
Chart 3 – Fractures aethiology at the STOMF of Bauru–SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
45,0%
40,0%
35,0%
30,0%
25,0%
20,0%
15,0%
10,0%
5,0%
0,0%
Fracture aethiology on the
Surgery and Traumatology Oral
Maxillofacial Service HB/FAMESP – BAURU.
Chart 4 – Fractures aethiology at the STOMF of Bauru–SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Fractures aethiology at the Surgery
and Traumatology Oral
Maxillofacial Service of
Bauru – SP.
Car Accident
Fall from own height
Physival agression
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
167
FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
Chart 5 – Jaw fractures aethiology at the STOMF of Bauru–SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Jaw fractures aethiology at the
Surgery and Traumatology Oral
Maxillofacial Service of Bauru – SP.
Car accident
Fall from own height
Physical agression
Attempted suicide
Chart 6 – Zygoma fractures aethiology at the Surgery and Traumatology Oral Maxillofacial
Service of Bauru – SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Zygoma fractures aethiology at the
Surgery and Traumatology Oral
Maxillofacial Service of Bauru – SP
Car accident
Fall from own height
Physical agression
Ox stepping
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
168
FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
Chart 7 – Panfacial fractures aethiology at the Surgery and Traumatology Oral Maxillofacial
Service of Bauru – SP.
Source: Surgery and Traumatology Oral Maxillofacial Service - HB/FAMESP – BAURU.
Panfacial fractures aethiology at
the Surgery and Traumatology Oral
Maxillofacial Service of Bauru – SP
Car accident
Physical agression
Ox stepping
DISCUSSION
This study is in agreement with the literature where facial
trauma is observed daily on hospital emergency services and affects mostly
the youngest population, being the main causes traffic accidents and physical
aggression (MARZOLA, 2008 and MARQUES; GUEDES; SIZENANDO,
2010). The detailed epidemiology study of facial trauma is extremely
important for patients to be submitted to the most appropriate treatment. The
evaluation of the facial fractures incidence and aethiology consequently
allows a more accurate and appropriate treatment.
Studies report that the Bauru Base Hospital, São Paulo, Brazil
is a reference in Oral and Maxillofacial Surgery service in the central-western
state of São Paulo, corroborating to the research conducted (MARZOLA;
TOLEDO-FILHO; SÁNCHEZ-TORO, 2005 and MARZOLA, 2008). This
information conforms to the present day, where the Bauru Base Hospital
follows as a reference in Oral and Maxillofacial Surgery in the region.
The research results corroborate with the literature reporting
that 446 fractures analyzed in a one year period, 195 (43.72%) corresponded
to nasal fractures, adding nearly half of all fractures found and that the male
was most affected (66.66%).
Taking into consideration the aethiology, the results differ from
those where the accidental fall or car accidents were the main cause of those
fractures, supporting studies where physical aggression was the main
reason, being represented in this research for 29.74% patients. (MARZOLA,
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
169
FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
2008 and FERREIRA; OLIVEIRA; MARZOLA, 2011). This is due to the
population social class, which influences the aethiology of trauma.
Traffic accidents in general, automobile, motorcycle, cycling and
pedestrian accidents are reported in the literature as the main cause of
fractures, reaching an incidence of up to 90.1% of cases. Other etiologies
most frequently cited include interpersonal aggression, falls and daily
activities. This study confirms the literature, however this varies in relation to
the incidence, therefore, in the literature, this percentage reaches up to
90.1% of cases and, in this study, showed an incidence of 42.5%
(AUGUSTO CLARO, 2003; MANTOVANI; CAMPOS; GOMES et al., 2006 e
MARZOLA, 2008).
Studies indicate that physical aggression were the most
frequent aethiology involving 27.9% of cases diverging from this study, which
presented the main aethiology car accidents (MARZOLA; TOLEDO-FILHO;
SÁNCHEZ-TORO, 2005 and MARZOLA, 2008).
This study is consistent with the literature where the most
common etiological agent was the automobile accidents, in a total of 26.67%.
Adding all traffic accidents amounts up to 42.97% of the cases (SOUZA
SILVA; TOLEDO FILHO; MARZOLA et al., 2005 and MARZOLA, 2008).
Car accidents are still common in the society even with efforts to better
population knowledge about the dangers, more measures become necessary
to reduce this number.
Regarding facial fractures incidence, this study differs from the
information obtained on the literature because presented nasal fractures in
the majority of the cases (35%), when the data found in the literature
mentions the jaw as the most fractured structure in facial trauma cases
(MARZOLA, 2008; MARQUES; GUEDES; SIZENANDO, 2010 and
NORONHA FILHO; VALENTE; KOSLOWSKY, 2012). Nasal fractures are
most common among the facial fractures, since this is the most prominent
bone of the face.
Exists correlation between this study and the literature which
states that after analyzing 1492 patients, over a period of five years, a total of
1598 facial fractures, were observed 775 nasal fractures (48.49%) followed
by 483 zygomatic complex jaw fractures (30.22%). The age of the patients
treated ranged from 1 to 99 years, being the most affected individuals
between the second and third decade of life. The facial fractures main
aethiology observed was the physical aggression, represented by 482
fractures (30.16%), followed by accidental falls, with 357 cases (22,34%)
(REIS; MARZOLA; TOLEDO FILHO, 2001 and MARZOLA, 2008).
This study corroborates with the literature regarding the nasal
fractures that ranks first in facial fractures prevalence and the leading nasal
fractures cause are physical agressions, followed by falls from own height
and car
accidents (MARZOLA, 2008 and FERREIRA; OLIVEIRA;
MARZOLA, 2011).
In this study, the data obtained in the Oral and Maxillofacial
Surgery service of Bauru, São Paulo, Brazil, shows accordance with the
literature in relation to gender, since facial fractures occur predominantly in
male patients (KRAUSE; SILVA JUNIOR; SCHNEIDER et al., 2004;
MARZOLA, 2008 and DAL PONTE; ROSA; MARZOLA et al., 2011).
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.
170
FACE FRACTURES AETHIOLOGY AND INCIDENCES IN THE SURGERY AND
TRAUMATOLOGY MAXILLOFACIAL SERVICE BASE HOSPITAL BAURU, SÃO PAULO, BRAZIL
This study confirms the literature where, from 251 jaw fractures,
80% were from male gender and only 20% were from female gender, aspect
perfectly comparable with the great majority of researchers who also found
this disproportion (MARZOLA; TOLEDO-FILHO; VILA-REAL and
MARZOLA, 2008). This higher rate may be accepted by assigning male
greater exposure to daily activities such as heavy lifting; that the largest
numbers of drivers are male, the largest force in violent sports and the
greater predisposition to interpersonal violence.
This study confirms the literature with a higher prevalence of
nasal fractures due to its central position and projection on the face, being
fractured extremely easily because of the thin bones structure that
constitutes it (ROCHA; MANGANELLO-SOUZA, 2006 and MARZOLA,
2008). According to these reasons, it is possible to understand the higher
nasal fractures prevalence in ambulatories of Traumatology and Oral
Maxillofacial Surgery.
CONCLUSIONS
Based on information obtained in the study realized, can be
concluded that:
1. Facial fractures are common and mainly caused by car
accidents, physical agressions and falls.
2. The facial bone most affected is the nose followed by jaw and
zygomatic.
3. The facial fractures incidence of occur more frequently in
male patients.
4. In nasal fractures cases, the most frequent aethiology is the
physical aggression, while jaw and zygoma fractures are caused by car
accidents.
5. The nasal bone is the most affected due to its central position
and projection on the face, being fractured extremely easily because of the
thin bones structure that constitutes it.
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___________________________________
* According to the ABNT and modified by the course.
o0o
PEREIRA MARQUES, N.; MARZOLA, C.; PASTORI, C. M. et al., Face fractures aethiology and incidences in the
Surgery and Traumatology Maxillofacial Service Base Hospital Bauru, São Paulo, Brasil. Rev. Odontologia (ATO),
Bauru, SP., v. 14, n. 3, p. 159-171, mar., 2014.