key: cord-0935072-3c0rf9i5
authors: Philip, George; Dominic, Shiney; Poorna T, Anish; Ek, Joshna
title: Pattern of maxillofacial fractures in a Tertiary Referral Centre in Central Kerala - A comparison between the Pre-COVID and COVID periods
date: 2021-10-21
journal: J Oral Biol Craniofac Res
DOI: 10.1016/j.jobcr.2021.09.021
sha: b4f0fa4aa6da8e5711c6d7bac7376a1328ac59bb
doc_id: 935072
cord_uid: 3c0rf9i5

Our aim was to observe if there was any appreciable difference in the etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods in Central Kerala, South India. This retrospective study was conducted with data over a period of two years from the central database registry of our hospital. Age, sex, etiology, date of injury, and site of facial fractures were recorded and compared between both the time periods. Increase in facial fractures due to fall at home (p value < 0.01) and decrease in mass casualty cases (p value < 0.01) were observed during the COVID-19 period. Pedestrians involved were significantly more in the pre-COVID-19 period (p value < 0.01) and heavy vehicle accidents producing facial fractures were significantly more in the COVID-19 period (p value < 0.01). Frontal bone (p value = 0.008), nasal bone (p value < 0.001) and zygomatico-maxillary complex fractures (p value < 0.001) occurred significantly more in the COVID-19 time period whereas naso-orbito-ethmoidal (p value = 0.003), mandibular (p value = 0.011) and dentoalveolar fractures (p value < 0.001) were seen significantly more in the pre-COVID-19 period. There was decrease in the total number of maxillofacial cases during the COVID-19 period. However, this was not significant when only the number of facial fractures were compared between the two periods. This study provided an insight on the differences in etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods. Road traffic accidents involving two wheelers predominate during the COVID-19 period also, prompting further critical exploration of the reasons behind this finding.

J o u r n a l P r e -p r o o f Introduction:

The COVID-19 pandemic has ineffaceably affected the Health care system worldwide over the past couple of years. The first case of COVID-19 in Kerala, South India, was reported on the 30th of January 2020 1 

Results:

A total of 2600 cases fulfilled our inclusion criteria with frequency of 1691 in the Pre-COVID-19 and 909 during the COVID period. A significant number of maxillofacial fracture cases were males (n=2127) accounting for 81.8% of the study population totally.

The age of patients reporting with maxillofacial fractures varied from 10 months to 98 years.

Most maxillofacial fractures occurred in the third decade in both the groups. There was no statistical difference on comparison between the two groups with respect to age (p value=0.061). Though the number of males with facial fractures reporting to ED was much higher than the females in our study period, on comparing their proportions, there was no statistical difference between them in the pre-COVID-19 and COVID-19 periods (p value=0.720).

RTA was the most common etiology in both the pre-COVID-19 and COVID-19 periods. In group 1, males (68.3%) had significantly higher occurrence of facial fractures due to RTA than females (48.6%) whereas females (9%) had significantly higher occurrence of facial fractures in a mass casualty than males (2.5%). In the same group, facial fractures due to fall at home was seen to be significantly higher among females (20.6%) than males (7%). Rest of the etiology of facial fractures were found to be non-significant between males and females in Table 1 .

Among the patients with facial fractures due to RTAs, two wheelers were the most common vehicles involved in both the group 1 and group 2. However, the occurrence of facial fractures in pedestrians were significantly higher (p value <0.01) in group 1 than in group 2 and facial fractures due to heavy vehicle RTA surprisingly higher (p value <0.01) in group 2 than group 1. As shown in Table 2 , rest of the variables compared between the two groups were not statistically significant.

Dentoalveolar fractures were the most common fractures in both the groups. Frontal bone fractures were significantly higher in males (12.8%) than females (5.5%) whereas dentoalveolar and primary tooth fractures were significantly higher in females (50.8%) and

(1.3%) than males (38.6%) and (0.2%) respectively in group 1. Frontal and nasal bone fractures were significantly higher in males (16.5%) and (14.3%) than females (8.6%) and (3.1%) respectively whereas primary tooth fractures were significantly higher in females (2.5%) than males (0.1%) in group 2. A significant difference was found between group 1 and 2 with respect to frontal bone (p value=0.008), nasal bone (p value <0.001), and ZMC fractures (p value <0.001) occurring more during the COVID-19 period whereas NOE (p value=0.003), mandibular (p value=0.011), and dentoalveolar fractures (p value <0.001) occurred more during the pre-COVID-19 period as shown in Table 3 .

As seen in Graph 1, the proportion of total maxillofacial cases including those with and without Discussion:

The COVID-19 pandemic is a never-before-experienced disaster that produced a huge burden to the healthcare and economy of all the affected countries. As the mankind was not prepared to face such a threat, the initial steps to defend the virus were aimed at the prevention of its Conclusion:

The unprecedented COVID-19 has resulted in unforeseen disturbances in human life worldwide. Nature and etiology of trauma is expected to be altered due to the changes in the mobility of individuals in the society. There was a drastic decrease in the aggregate of facial trauma cases during the COVID-19 pandemic period. However, our study did not show any significant difference on comparing the two groups with respect to age and sex. Facial fractures due to fall at home were seen significantly more during the COVID-19 period and mass casualties were significant in the pre-COVID-19 period. Road traffic accidents involving two J o u r n a l P r e -p r o o f wheelers predominate during the COVID-19 period also, prompting further critical exploration of the reasons behind this finding.

The authors did not receive any external source of funding.

All the authors associated with present manuscript declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Institutional Ethical Clearance was obtained from the Institutional Review Board. 

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