Changes in the epidemiology of facial trauma and their implications


Face trauma has evolved significantly over the years in terms of aetiology, age range, gender, distribution, and severity. Many epidemiological studies have been published in the literature in an attempt to create a profile of facial trauma. Factors influencing the incidence of maxillofacial fractures were evaluated in a recent literature review published in 2012 by Chrcanovic1. In terms of age, the highest incidence occurs before the age of 35, with 65-96% of cases occurring in the third decade of life. Thirty percent of people over the age of 65 suffer from visual impairment. Another intriguing fact is that condylar fractures are the most common type of paediatric trauma.

When it comes to gender, men have a clear advantage in fractures, with a ratio ranging from 2:1 to 32:1. This is due to the fact that women are more restricted to domestic work and are more cautious in traffic; additionally, they occasionally participate in commerce and agricultural activities, and are less vulnerable to accidents caused by fights, industrial work, and sports practise.

Other factors that influence the incidence of maxillofacial trauma include: cultural aspects and geographic region, socioeconomic conditions, climatic and seasonal influences, as traumas are more common on weekends and in the summer months, especially in countries where seasons are well defined, alcohol and drug use, traffic laws, domestic violence, and osteoporosis, which appears to predispose to facial fractures in the elderly, particularly women.

Brazil, a continent-sized country, has epidemiological variability in facial trauma that varies depending on the region studied. Melo discovered that traffic accidents accounted for approximately 37.2% of all cases of facial trauma in Recife, followed by falls (30.6%) and physical aggression (23%), accounting for 90.8% of all cases.

Trauma is also a significant public health issue because it is linked to socioeconomic, urban and rural changes, and people's conflicted relationships. Interpersonal physical aggression in traffic, sports practise, at home, and even major military conflicts results in significant physical and financial losses. When compared to patients admitted to the emergency room for other injuries, the effective cost of treating isolated facial fractures is quite high. These findings speak volumes about the importance of trauma education and prevention policies, as well as the need for professionals working with facial trauma to be well-versed in traumatology, craniofacial anatomy, and physiology.

The face is usually the only part of the body that cannot be covered. It is the focal point of human relations, where one can identify genetic characteristics, emotions from the past (wrinkles) and present (expression), age, intellect, and a variety of other characteristics of each individual. All of this increases the responsibility of professionals involved in the care of facial injuries to avoid causing an injury that will permanently scar the person who suffers from it. Furthermore, today's beauty cult produces in everyone, but especially in women, a refusal to accept the possible consequences of facial trauma.

We know that the more facial tissue is destroyed, the worse the consequences will be. Although an appropriately performed initial treatment that meets the standards established by the polytrauma care handbook "Advanced Trauma Life Support (ATLS)" can save lives, it does not guarantee the restoration of facial functions. It is important to remember that facial trauma complications can have serious consequences, such as phono-articulatory and visual disorders, the presence of hypertrophic scars, aesthetic deformities, and even psychological disorders. As a result, isolated measures that lack fundamental knowledge of the trauma process and what was restored and what was lost frequently yield poor results. To achieve a good outcome, multidisciplinary and integrated care is required to achieve the patient's perfect aesthetic and functional recovery.