key: cord-0959198-xpo5b8hs authors: Boom, L. J.; Wolvius, E. B.; Rozeboom, A.V.J. title: Impact of COVID-19 lockdown on incidence of maxillofacial fractures: A retrospective analysis date: 2022-04-12 journal: Advances in Oral and Maxillofacial Surgery DOI: 10.1016/j.adoms.2022.100289 sha: 83ddb42b0c9ff924b2ec0adc4007e3f9023cc423 doc_id: 959198 cord_uid: xpo5b8hs COVID-19 lockdown restrictions greatly influenced people's behaviour and movements, and therefore patient presentation may differ in maxillofacial trauma surgery during lockdown. The aim of this study is to evaluate the impact of a lockdown on the incidence, types and mechanisms of injury of maxillofacial fractures. In this single-centre retrospective cohort study patients who visited the maxillofacial surgeon after traumatic injury between the 15th of March and the 1st of June in the years 2018, 2019, 2020 and 2021 were included. The primary outcome is the incidence of maxillofacial fractures during the lockdown in 2020 compared to the pre-lockdown and post-lockdown periods. Secondary outcomes are type of fracture and mechanism of injury. A total of 130 patients with maxillofacial fractures were identified. During the lockdown 0.51 (95% CI 0.32–0.84) times less maxillofacial fractures were reported. A significant association was found between mechanism of injury and lockdown compared to the post-lockdown period. No further associations were found between a lockdown and type of fracture or mechanism of injury. In conclusion, the incidence of maxillofacial fractures was significantly lower compared to equivalent time periods in other years, but recovered after lockdown. After the first human cases of coronavirus disease (COVID-19) emerged in early December 26 2019, the virus was genetically identified as SARS-CoV-2 and globally shared on the 11 th of 27 January 2020. The virus has greatly stirred the world since, achieving the status of pandemic 28 on the 11 th of March 2020. 1 Governments were forced to implement severe measures to 29 prevent exponential transmission of the virus. In many countries the rapid spreading 30 inevitably led to nationwide lockdowns, the Netherlands included. The strict social and public health measures greatly influenced people's behaviour. In 39 traumatology it is known that fracture epidemiology primarily depends on human behaviour 40 and lifestyle. [5] [6] [7] [8] In the past, nationwide health emergencies such as natural disasters have 41 influenced epidemiology of pathologies that normally occur in the population. 9-11 The 42 COVID-19 pandemic may be considered as such a rare event. It is therefore a reasonable 43 assumption that the pandemic and related lockdowns may impact patient presentation. 44 Severe facial injuries involving mobility and bleeding of facial bones may promote life-45 threatening airway obstruction and hypovolemia. 12 Therefore traumatology is an important 46 subspeciality in maxillofacial surgery that needs continuation of patient care, especially in a 47 state of national health emergency. 48 J o u r n a l P r e -p r o o f Differences in patient presentation may alter the demand for specific healthcare resources 49 and therapies. Due to the pandemic, the presentation of patients, medical staffing levels and 50 provision of resources are subject to change across almost all medical fields, with no 51 exception for maxillofacial surgery. 13 Efficient reallocation is therefore necessary to ensure 52 qualitative and sufficient patient care, especially for immediate and unscheduled 53 maxillofacial trauma surgery. Epidemiological analysis of maxillofacial fractures during an 54 unprecedented pandemic provides crucial insights to ensure adequate patient care. 55 Eventually these new insights allow healthcare workers and policymakers to develop an 56 efficient planning system for resource allocation to sustain future health crises. Pre, lock and post stand for pre-lockdown, lockdown and post-lockdown group respectively. The first P-value 278 represents the comparison between pre-lockdown and lockdown group. The second P-value represents the 279 comparison between lockdown and post-lockdown group. For Poisson regression data were put in by year, 280 producing only one p-value. ZMC = zygomatic maxillary complex. World Health Organization Emergency Committee. 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What Is the Effect of COVID-19 Social Distancing 259 on Oral and Maxillofacial Trauma Related to Domestic Violence?