relationship with the help of interocclusal recording ring that fits around the borders acts as a mold for the metallic die and were copied in the samples during Table-I: Distribution of horizontal distance in group A materials. These materials should have good dimen- impression material. The thickness of ring was 0.3 cm their fabrication. sional stability to achieve proper articulation4. Many and the diameter of the ring was 3cm. Therefore the The distance between the two reference points of materials are available for interocclusal record. These stainless steel die include stainless steel ring and each sample (A1_C1, and A2_C2) were measured by include: Bite registration wax (Aluwax, HiFi, base- stainless steel test block. The distance between the a traveling micrometer microscope. It had a millimeter plate), zinc-oxide eugenol paste, Addition silicone two parallel reference lines A and C was measured at scale and a vernier scale which were attached (polyvinylsiloxane), Polyether elastomer, Impression two fixed points. These reference points were scribed together and with the help of vernier scale it was compound, Impression plaster of paris, Acrylic resin, in the metallic die and were copied in the sample possible to measure up to 10 micrometer i.e. 0.01 Thermoplastic resin, Alginate (irreversible hydrocol- during their fabrication. millimeter. The two reference points between the loid), Condensation type silicone, Eugenol free zinc For polyvinylsiloxane specimen: vertical parallel line were measured through a magni- oxide eugenol paste4,5,6. Intercclusal recording mate- Two equal length of base and catalyst according to fying tube attached with the traveling micrometer rials are basically similar to impression materials but the manufacturers recommendation and kneaded microscope. At first reference point A1 was placed GroupA: polyvinylsiloxane; n:Total number of sample are modified to give good handing characteristics4. with clean finger instead of wearing latex gloves to beneath the magnifying tube on the platform of the Table-I shows that mean±SD was 6.00±0.00 after Each of these has advantages and disadvantages as prevent sulfur contamination from these gloves which microscope. The measurement M1 was recorded by one hour follow up visit 5.97±0.38 after 24 hours, interocclusal recording materials. In Bangladesh inhibits the setting of the addition silicone interocclu- the following formula. M1= (Reading of millimeter 5.92±0.04 after 48 hours and 5.82±0.04 after 72 most popular interocclusal recording materials are sal recoding material and may produced major distor- scale + Reading of vernier scale x vernier constant i.e hours follow up visit. It was indicated that maximum alginate5. Alginate has limitation but it also has some tion. Then kneaded material together (approximately 0.01) mm. Then the platform was horizontally moved horizontal distance between A & C after one hour advantages too over the other materials that make it 45 seconds) until a uniform, streak free color was without shifting the sample and with the help of rotat- follow up visit and minimum horizontal distance more valuable. Because of its extreme fluidity before achieved. It was then placed on the surface of the die ing the platform screw. Now reference point C1 was between A & C after 72 hours follow up visits. setting and its resilency after setting, alginate causes for impression making. fixed under the magnifying tube. The measurement Table II: Distribution horizontal distance in different minimal tooth and tissue displacement when occlusal For alginate specimen: M2 was measured by the same formula. Measure- follow up of group B registrations are made with it5. Posselt thought that For mixing alginate powder and water were meas- ment of the distance between A & C parallel lines at alginate records were superior to wax, but shrinkage ured according to the manufacturer’s recommenda- reference point between A1C1 is done by subtracting made them useless after a few minutes7. The dimen- tion at room temperature. The measured powder M1 from M2. So A1C1=M2-M1. In the same way, sional stability of interocclusal recording materials (9gm) was shifted into premeasured water (17ml) that horizontal distance between A2_C2 was measured. over time is of utmost importance, as it ensures a had already been poured into a clean rubber bowl. The mean of two readings were used for calculation more accurate representation of the patient's maxillo- The powder was incorporated into the water by care- for each sample. Reading was recorded for all 10 mandibular relationship10. So the study was done to fully mixing. Mixing time (30 seconds) was carefully samples of each group at intervals of 1 h, 24h, 48h & compare the dimensional stability of polyvinylsilox- maintained and after that it was placed on the surface 72 hours. The measurement data was collected from ane and alginate at various times of intervals (1h, 24 of the die for impression making. samples of each group and was recorded in data hs, 48 hs, 72 hs). Sample collection: collection sheet. Horizontal linear distance between Group B : Alginate; n:Total number of sample After homogenous mixing, the materials were carried A1 C1 and A2 C2 is measured in millimeters. Table-II shows that mean±SD was 5.68±0.05 after Materials & Methods to the die. The stainless steel die was inverted on to a Statistical analysis: one hour follow up visit, 5.56±0.02 after 24 hours, Introduction lation. In these situations, the patients’ interocclusal This comparative in vitro study was carried out 4x4 inch square glass plate covered with polyethyl- Data analysis was done by using computer based 5.49±0.03 after 48 hours and 5.41±0.06 after 72 Inter occlusal records are the means whereby inter records are made and sent along with the cast to the Department of Prosthodontics, BSMMU, Dhaka, from ene sheet. Hand pressure was applied for about five program SPSS (Statistical Package for Social hours follow up visit. It was indicated that maximum arch relationship are transferred from mouth to an laboratory. This requires that the records must be June 2009 to 2010. Duplicated disk of polyvinylsilox- seconds initially to express the materials followed by Sciences) version 12. Paired t test was done to find horizontal distance after one hour follow up visits and articulator1. Maxillomandibular records are necessary dimensionally stable for the given period of time ane and alginate obtained from custom made stain- application of a 500 g weight to further remove of out statistical significance value. The results were minimum after 72 hours follow up visits. 2 to study the status of the dentition and to construct before they are used to articulate the casts . Record- less steel die were used as a sample. The sample excess materials. Each assembly remains for the presented in tables and figures. The result of signifi- Table III: Comparison of horizontal distance in group dental restoration. One type of record is used for ing maxillomandibular relationship is an important size of the study was twenty. Only freshly prepared manufacturer suggested setting time ie alginate for 2 cance was expressed as p value. P value <0.05 was A and group B mounting casts of the teeth or setting the articulator step in oral rehabilitation. This relationship is trans- duplicated disks from die were selected. minutes 20 seconds and additional three minutes to considered as significant. adjustments and another for appraising the degree of ferred to the articulator so laboratory procedure done Group of sample: ensure polymerization of materials. The mold assem- occlusal or incisal tooth contacts2. Adequate laborato- on the cast will be corresponding with patients’ Group A: 10 disks were made with polyvinylsiloxane. bly was removed from the stainless steel die and all Results 3 ry facilities are commonly not available locally and mouth . To create a harmonious occlusion, it is Group B: 10 disks were made with alginate. excess materials were trimmed. Samples were stored The present in vitro study was intended to compare casts have to be sent to others laboratories for articu- essential to record the existing maxillomandibular Preparations of stainless steel die: in room temperature. Later specimens were prepared the dimensional stability of polyvinylsiloxane and The stainless steel die had two portions: a round in the form of a disk measuring 3cm in diameter with alginate at various times of intervals. Total 20 sam- stainless steel test block and a stainless steel ring4 three parallel lines on the surface. ples were evaluated. The findings of the study that fits around the borders and acts as a mold for the Measurement of the test samples: obtained were analyzed and presented below. specimen. A round stainless steel die was construct- These three lines were named A, B & C which were ed for testing dimensional change. Three parallel equally separated by a distance of 3 mm. The lines were included on the die surface. These three distance between the two parallel reference lines, A & C, were measured at two fixed points (A1C1 and Group A polyvinylsiloxane, Group B Alginate, The mean lines were named A, B and C which were equally difference is considered significant if p< 0.05. * Significant separated by a distance 3 mm. The stainless steel A2C2). These reference points were scribed in the

Original Article UpDCJ | Vol. 7 No. 1 | April 2017

Table-III shows that after 1 hour follow up visit Conclusion Pattern of Maxillofacial Trauma among Patients (RTC) were the most frequent cause of facial energy trauma causing maxillofacial injury are high the Oral and Maxillofacial surgery Department. Figure 1: Sex distribution of the patients (n=60) Table 3: Distribution of fracture facial bones (n=60) Table-5: Cross tabulation between pattern of facial 8.09:112. This indicates that males are more prone to beaten by her male partner and/or family members mean±SD was 6.00±0.00 in group A and mean±SD In this study we concluded that dimensional stability injuries7,8 However more recent studies have shown enough to cause concomitant head injury1,2,3,4. The fracture and severity of head injury (n-60) maxillofacial injury with or without head injury this for dowry for other reasons. We found only 1.7% in was 5.68±0.05 in group B. After 24 hours follow up is influenced by both Material and time factors. It with Head Injuries that assault is now the most common cause of maxil- purpose of this study was to evaluate the pattern of Statistical analysis high vulnerability of male gender for all type of trauma our study. visit mean±SD was 5.97±0.08 in group A and decreased as the time factor is increased. Polyvinyl- Dr. Abul Hasnat1, Dr. A.K.M. Erfanul Hoque2, Dr. Md. Selim-Ul-Azam3, lofacial injuries in developed countries9,10 where as head injuries in Patients with maxillofacial trauma and After the patient had given consent to be included in can be attributed to the fact that in our society males Isolated mandible fractures are most common facial mean±SD was 5.56±0.02 in group B. After 48 hours siloxane were dimensionally more stable than Dr. Mohammad Kamrujjaman4, Dr. Mahmuda Akhtar5 traffic accidents remain the most frequent cause in to co relate the relationship between them. the study, a standardized structured data collection are predominantly the bread bearing for the family. bone to be fractured ranging from 12.9% to as high as follow up visit mean±SD was 5.92±0.04 in group A alginate interocclusal material. many developing countries11 like Bangladesh. Others sheet was used to collect necessary information of Moreover they are at higher risk of injuries than 72.9%, followed by midface ranging from 25.9% to and mean±SD was 5.49±0.03 in group B. After 72 Received: 15 February 2017 Accepted: 09 April 2017 causes of maxillofacial trauma are fall from height, Material and methods: the study subject. The data were screened and women because of their greater exposure of automo- 29.5%11,12,21 the other frequently affected bones are hours follow up visit mean±SD was 5.82±0.04 in References assaults, altercation, pedestrian injury, home and This was a descriptive type of cross-sectional study checked for any missing value and discrepancy. The bile and motorcycle accident and engaged in more the floor of the orbit and nasal bones. However, in the group A and mean±SD was 5.41±0.06 in group B. Abstract: industrial accidents and athletic injuries, in descend- carried out at the department of Oral & Maxillofacial data were then processed and analyzed using statis- risky behavior like hanging on the side of the bus or present series, the most frequent maxillofacial injury 12 The difference was statistically significant (P<0.05) 1. Skurnik H. Resin registration for interocclusal recods. J Background: Patients with maxillofacial trauma are at high risk of having traumatic cranial injuries. ing order of frequency . Surgery, Bangabondhu Sheikh Mujib Medical Univer- tical software SPSS (statistical Package for Social rush to get in a running bus. represented was the fractured mandible 36.6%, between group A and group B in different follow up ProsthetDent.1977;21(2):164-170. Prompt determination of head injury in these patients is crucial for improving patient’s survival and The peak age of incidence of maxillofacial injuries sity, Shahbag, Dhaka. The period of study was from Science) version16. Chi- square test was carried out In our study, it was found that majority of patients followed by fractured Zygomatico-maxillary complex visits. smooth recovery. Objective: The purpose of this study was to find out the pattern of maxillofacial among 21 -30 years13 and more males are involved in 1st May 2010 to 30th April 2011. The patient’s data and significant level p value of < 0.05 was considered were in the age group between 2nd to 4th decade including orbit and Lefort fractures. In a survey by 2. Dua MP, Gupta SH, Ramachandran S, Sandhu HS. injuries in a patient with head injuries and to study their relationship. Study design: A prospective maxillofacial injuries than females14. Children are were collected from Inpatient department of Neuro- statistically significant. The summarized data were and mean age was 29.63 years which is similar to Malara P et ai in 2006, they found in 198 patients that Evaluation for four elastomeric interocclusal recoding mate- Fig-1: Shows that among patients with both maxillofacial 21 Discussion Cross-sectional descriptive study was made over 60 patients. Study setting and period: The study uniquely susceptible to maxillofacial injury because of surgery, Dhaka Medical College &Hospital and inpa- present in the form of tables, graphs and bar other studies of the globe. The possible explanation 18.69%suffered mandibular fracture, 12.63% Zygo- rials. MJAFIl. 2007 ;63 (3) : 237-240. 15 and head injury 88.3% were male and 11.7% were female. The linear dimensional changes of two interocclusal was conducted in the Department of Oral & Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical their disproportionate cranial-body mass ratio . tient department of Oral and Maxillofacial Surgery, diagrams by the help of statistician. S = Significant for this is that the people in this age group take part in matic complex fracture and 12.2% maxillary Patients older than 65 years account for approxi- dangerous exercise and sports, drive motor vehicles fractures22. Obuekwe and Etetafia in 2004 found in recording materials were measured over time in this 3. Tripodakis AP, Vergos VK, Tsoutsos AG. Evaluation of University, Shahbag, Dhaka-1000 from May 2010 to April 2011. Participants: Sixty patients with max- Bangabondhu Sheikh Mujib Medical University, Table 2: Distribution of mode of injury (n=60) Table-3: Shows mandible was the most commonly Table-5: indicates that most of the zygomatic- maxillary mately 1% of maxillofacial trauma, and falls on a carelessly and are more likely to be involved in their study, that mandible was the most common site study. These measurements provided an indication of the accuracy of interocclusal records in relation to two illofacial and head injuries were selected for the study. Methods: It was a prospective cross-sectional Shahbag, Dhaka who were referred from other Results and Observation: fractured facial bone (36.67%) (n=22) at different anatomi- complex fracture including orbit occurred in case of moder- the dimensional stability of those materials. However, recording techniques. J Prosthet Dent.1997; 77 (2): slippery ground is the most common cause in this age Neurosurgical center. The total of 60 patients who cal locations. Both Zygomatico-maxillary complex fracture ate head injury and most of the Lefort-II fracture occurred in violence. Patients less than 10 years and more than of fracture, followed by Zygomatic complex and max- descriptive hospital based study. 60 patients who were diagnosed of having concomitant maxillofacial 16 23 dimensional stability can also be studied in all the 141-146. group . sustained both cranial and facial injuries were includ- and Lefort-II fracture were equal frequency 18.3% (n=11). patients with moderate and severe head injury. And most of 60 years were less frequently affected in our series. illa . The results of our study therefore correlate with and head injuries were included in this study. Information’s based on age, sex, mode of injury, pattern Table-1: Age distribution of the study subjects (n=60) three planes using equipments like the condymeter, It was evident that the facial bones fractures were ed in this study. After taking informed consent, data the Lefort-III fracture occurred in patient with severe head These could be explained that children are usually other literatures. computerized Axitron and Buhnergraph4. Table 1 4. Karithikeyan K, Annapumi. Comparative evaluation of of facial and head injury, GCS score and type of head injury were taken for each case. Appropriate uncommonly singular with compound and comminut- were collected by history, through clinical examina- Table-4: Distribution of involvement of cranium (n=60) injury. taken care of by elders during travelling and lesser In this study we found among LeFort fractures shows group A exhibited no significant difference dimensional stability of three types of interocclusal record- skull X-ray was done for all patients with maxillofacial injury and patient’s with initial sign of neurologi- ed nature adding on to the complexity of facial tion, radiographic evaluation and Neurosurgical mobility of geriatric people. But the effect of head LeFort- ll is more common (18.3%), than LeFort lll Graph 3: Correlation between pattern of facial fracture between the die scribe and those of the sample at the ing materials: an in vitro study. Journal of Indian Prostho- cal deficit an initial CT scan of brain was done. Data was analyzed using the SPSS program. Results: fractures. It is a common concept of fracture nasal consultation. Appropriate skull X-Rays were done in injury is disproportionately severe in elderly and they (11.7%) and LeFort – l. The pattern is identical to dontic Society.2007; 7(1) :24-27. and severity of head injury 15 immediate reading. Nisan et al2 observed that addi- Majority of the patients were in the 2nd to 4th decade (75%) with a male to female ratio of 7.57:1 Motor bone being the most common facial bone to be all patients and patients with impaired conscious- require more neurosurgical care. studies conducted by Haug HR, Foss J. in 2000 . tion type silicone, polyvinyl siloxane is most accurate vehicle accidents were the most common cause of injury (60%), followed by fall from height (13.3%).- fractured, then the zygoma followed by mandible and ness, neurological sign or clinical sign of basal skull The main causes of craniofacial injury worldwide are Our results demonstrated lower incidence of Nasal 5. Scott WR .Occlusal registration using alginate (irreversi- 17 and stable interocclusal recording material. Table II ble hydrocolloid) impression material.J Prosthet Dent. Mandible was the most commonly fractured facial bone (36.67%), followed by midface fracture maxilla. fracture, an initial CT scan was also performed. assaults and road traffic accidents, but the preva- bone fracture (5%), although it is a common concept shows in group B the same result. Table III shows 1978;40(5) :51 7-519. (18.3%).Majority of the patients had moderate head injury and were managed conservatively. Among Apart from maxillofacial injury, high velocity impacts Information regarding age, gender, cause of injury, lence varies depending on the demographics and of fracture Nasal bone is the most frequent facial comparison of horizontal distance between group A depressed fracture of skull, frontal bone was most commonly affected. Conclusion: Adult males were may result in fracture of facial bones and life threaten- pattern of facial and/or head injuries, loss of geography of the area. Road traffic accidents (RTA) bone to be fractured. It probably comes from the fact Table 2: indicates that majority of the victims suffered by and group B. The difference was statistically signifi- 6. Lassila V. Comparison of five interocclusal recording most common victims in craniofacial trauma, and road traffic accidents were responsible for the ing intracranial hemorrhages in different compart- consciousness, and GCS score were obtained and are the commonest cause of craniofacial trauma in that isolated Nose fracture was managed by other cant (p<0.05) of all follow up visit between group A material. J Prosthet Dent.1986 ; 5: 215-218. ments requiring urgent neurosurgical intervention19. A recorded in questionnaires. motor vehicle accidents (60%), (n=36) followed by fall from most of the series5,11,12,20 and this occurred largely in specialties like ENT and Plastic Surgery. majority. Most of the patients sustained moderate head injuries and were managed conservatively. height (13.3%) (n=8) and pedestrians (11.7%), (n=7). and group B. Above reports showed similar results8. decrease in the level of consciousness is the single The causes of injury were summarized as follows: our circumstance also (60%) because of reckless- GCS is a good marker for determining potential brain Open reduction and internal fixation with miniplates were used for displaced facial bone fractures. Some researchers carried out an experimental9 study 7. Eriksson A, Eriksson GO, Lockowandt P, et al .Materials most reliable indicator that the patient has a serious Motor vehicle accidents, Fall from height, Pedestrian, ness and negligence of the drivers, poor mainte- injury, clinical conditions and prognosis of the patients for reliable interocclusal measurements. Br Dent J.2002 Key Words: Maxillofacial trauma, head injury, facial bone fracture, Glasgow coma scale. 20 Graph 2: Distribution of Glasgow Coma Score (GCS) 24 and found that addition silicone presented smaller head injury or secondary insult to the brain . Loss of Assault, Sports injuries, Work-related injuries, and Mean ± SD = 29.63±12.0 Range = (5 - 64 years) nance of vehicles, often driving under the influence of following trauma . On the basis of GCS scores of the ;192 (7) : 385-400. intracranial hemorrhages, closed head traumas Majority of the victims were in the age group of 21 to of the patients (n=60) linear when compared to alginate. Moisture, especial- Introduction: consciousness is the manifestation of intracranial others. Table- 4: indicate that Linear fracture were more (31.6%) alcohol or drugs and complete disregard of traffic patients, It was found that, majority of patients with Maxillofacial trauma and concomitant head injuries (brain contusion or laceration), or fractures. General- 40 years (75%), with 21-30 years (51.7%) more ly, can cause considerable dimensional changes in 8. Lassila V, McCabe JF. Properties of interocclusal regis- injury or concussion head injury (62%), followed by Facial injuries included facial bone fractures and/or (n=19) then depressed fracture (n=16) and scalp injury. laws. Fall from height was the second most common head injury according to their GCS score were classi- carry the significant potential for mortality and neuro- ly, the presence of emesis, vomiting, loss of affected among this group. Children less than 10 yrs alginate. Therefore great care is taken wrapping and tration materials.J Prosthet Dent. 1985; 53: 100-104. headache (33%), vomiting (27%), nasal bleed (30%) soft tissue injuries. Facial bone fractures were classi- Discussion: cause of injury in our series and attributed to 13.3%, fied as having moderate head injury 55% (n=33), consciousness, or a low Glasgow Coma Scale (GCS) 21 and elderly >60yrs of age made up a less frequency. packaging them during storage and transfer. Few logical morbidity. Maxillofacial trauma can occur as and oral bleed (10%) . fied as mandibular, Lefort I, Lefort II, Lefort III, Zygo- Figure-2: Distribution of type of head injury (n=60) Bangladesh is a south Asian developing country this occurred mostly in urban area where lot of followed by severe head injury 20% (n=12),mild head score are important findings for suspicion of a cranial authors have suggested ideal times for articulation of 9. John J, Manapallil. Basic Dental Materials. 2nd ed .New an isolated injury or in combination with other severe The Glasgow Coma Scale score(GCS) is used to matico-maxillary fracture including orbit, and Nasal where poverty and unemployment forcing the people peoples worked as a day labour in construction of injury 15% (n=9), and minor head injury 10% (n=6) 1 injury. However, in patients with maxillofacial trauma, Graph 1: Age Distribution of the study subject (n=60) casts with respect to the type of interocclusal records Delhi: Jaypee Brothers medical publishers (p). Ltd.2003 : injuries . Patients with maxillofacial trauma may pres- quantify neurologic findings and it is widely accepted bone fractures. The types of mandibular fractures towards urban areas. This rapid and unplanned high rise buildings and painting them. It is in accord- respectively. The results from this study showed a head trauma may also be seen without observing the used. The result of this present study was consistent 58. ent with associated intracranial, pulmonary, intra-ab- and a standardized method for evaluating level of were classified by anatomic site (condyle, ramus, urbanization associated with incompetent traffic ance with others findings from South India, which significantly higher incidence of moderate type of 2,3 suggestive findings6. with the above study. Thus, it becomes mandatory to dominal or extremity injuries . A close relationship consciousness depending on the score of the GCS angle, body, symphysis, parasymphyses and coro- system, unplanned roads and highways, violation of reported 16,6% of Craniofacial trauma were due to head injuries associated with maxillofacial injuries as 10. Michalakis KX, Argiris P, Vassiliki A. Experimental The etiology of maxillofacial injuries varies from one 12 choose a material depending not only on the clinical between maxillofacial fracture and intracranial injury head injury can be classified as very mild, mild, mod- noid). traffic laws by the drivers and pedestrian injury, over- fall from coconut tree. In our study, we found, compared to other reports in the English literature. study on Particular Physical Properties of several Interoc- 4-6 country to another and even within the same depend- situation but also on the time taken for the articula- has been reported in many articles . In many coun- erate and severe head injury. About intracranial Head injuries included skull fractures and/or intracra- crowding, etc are responsible for highest figure of pedestrians constituted 11.7% of the total victims. In In case of head injury, various pattern of skull fracture clusal Recording Media. Part II: Linear Dimensional tries, cranial injury has been found to be the most ing on the prevailing socioeconomic, cultural and tion. From above study I found that dimensional Change and Accompanying Weight Change. Journal of lesions, contusion/ concussion, extradural hemato- nial injuries. Skull fractures were classified into scalp road traffic accidents, and these RTA victims are Dhaka city, a large number of pedestrians are were found. Linear fracture was the commonest type common accompanying organ injury in patients with environmental factors. Earlier studies from Europe changes of polyvinylsiloxane inter occlusal recording Prosthodontics. 2004 ;13(3) :150-159. ma, subdural hematoma, subarachnoid hematoma injury, linear fracture and depressed fracture of mainly suffered from Craniofacial injury. garments employees and day labor. They have lack (31.6%) followed by depressed fracture (26.6%). 3,4 and America revealed that Road Traffic crashes material was not significant in a horizontal plane after maxillofacial trauma . These includes head traumas, and intracerebral haematoma occurs most frequent- frontal, temporal, parietal, occipital, and basal skull Above figure indicates that most of the study population In the present study, majority of the head and of knowledge regarding traffic rules, shortage of Linear fracture was the commonest one because ly20. suffered from moderate head injury (55%), (n=33), followed space in footpath, most of which are occupied by the during RTA head strikes by forcible contact with broad 1 and 24 hours. The changes after 48 and 72 hours 1. BDS, FCPS (OMFS), Asst Professor & Head, Oral & Maxillofacial Surg, Dhaka Community Medical College fractures. Intracranial injuries were summarized as concomitant facial injuries were experienced by were lesser than other group. So it can be concluded Existing literature on the correlation of traumatic head concussion, cerebral contusion, and intracranial by severe head injury (20%) (n=12), mild head injury (15%), hawkers. Most of the pedestrians are not used to use resting surface like roads18. This result was identical 2. FCPS (Part-II) Examinee (OMFS) (n=9) and very mild head injury (10%) (n=6). males, constituted 88.3% and females constituted that polyvinylsiloxane is more dimensionally stable injuries and maxillofacial trauma Is highly controver- hemorrhage (epidural, subdural, intracerebral and the pedestrian’s bridge. That’s why pedertrain injury to other study done by Ahmed et al in 2009 in Bang- 3. FCPS Part-II Examinee (OMFS) Above figure indicates that, most of the study population only 11.7% of the total victims. The male to female sial. Some suggest that it is the facial skeleton that is a common cause of injury in our country. Domestic ladesh.20 Regarding depressed fracture of individual interocclusal recording materials than alginate. 4. BDS, FCPS (OMFS), Asst. Professor & Head, Oral & Maxillofacial Surgery, Bangladesh Dental College subarachnoid). Above graph indicates that 21-30 years age group was suffered from contussion (35%) (n=21). 18.3% had ratio was 7.57:1. These results are similar in a study absorbs the energy of the trauma, protecting the violence is another cause of craniofacial trauma in bones, Frontal was most prone to fracture (16.66%) 5. BDS, MS, FCPS, Associate Prof, Oral & Maxillofacial Surg, Bangabandhu Sheikh Mujib Medical University Brain trauma was handled by Neurosurgery depart- more commonly affected. subdural hemorrhage (n=11) and 15% had Extradural from India, where 89% of subjects were males and brain from injury, whereas, others suggest that high ment and complex facial fractures were repaired by haemorrhage (n=9). 11% were females, giving a male to female ratio our country, where the women are most of the time followed by fracture temporal bone (5%) and parietal Correspondence : Dr. Abul Hasnat, e-mail: [email protected], Cell: 01717-300982, 01617-300982 14

bone. This coincides with other study done previously closed head injuries than mandible fracture.19 These with panfacial fractures. J Trauma. 2007; 63:831-5. 16. Rehman K, Edmcndson H. The causes and conse- at BSMMU in Bangladesh in 2002.25 difference in the facial bone or head injury being stud- quences of maxillofacial injuries in elderly people. Gero- In agreement with a study by Pappachan and Alexan- ied and the variation in classification, nomenclature 3. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associ- dontology. 2002; 19:60-64. der, we observed that CSF rhinorrhoea was nearly or methodology of prior studies may explain these ated injuries in facial fractures: review of839 patients. Br J Plast Surg. 1993;46:635-8. 17. Khan AR, Arif S. Ear nose and throat injuries in children. twice as frequent as CSF otorrhoea.27 This may be conflicting result. In the present study we demonstrat- J Ayub Med Coll Abbottabad.2005; 17:54-6. explained by the fact that anterior Cranial base is ed that LeFort- lll fracture was the strongest predic- 4. Mulligan RP, Friedman JA, Mababir BC. A nationwide relatively closer to midfacial structures and has more tor of severe head injury, followed by LeFort- ll and review of the associations among cervical spine injuries, 18. Davidoff G, Jakubowski M, et al. The spectrum of sutural connection with midfacial bones compared to Zygomatico-maxillary fracture including Orbit this head injuries, and facial fractures. J Trauma. closed- head injuries in facial trauma victims:incidence and the middle cranial base. Thus, the chance of anterior coincide with the other findings done by Kloss et al. 2010;68:587-92. impact. Ann Emerg Med.1998; 17:6-9. cranial base fracture and resulting CSF rhinorrhoea is reported that LeFort- lll fracture was the strongest expected to be higher. predictor of intracranial bleeding. 5. Gwyn PP, Carraway JH, Horton CE, Adamson JE, 19. Egol R, Fromm KR, et al. Guideline for intensive care Similar to other studies the most common neurologi- Mladick BA. Facial fractures-associated injuries and unit admission, discharge, and triage. Cr/f Care Med 1992; complications. Plast Reconstr Surg. 1971;47:225-30. 27:633-638. cal symptom was loss of consciousness, which can Conclusion be manifestation of intracranial injury or concussion Adult males in the age group of 20-40 years were the 18,24 6. Kloss F, Laimer K, Hohlrieder M, Ulmer H, Hacki W, 20. Ahmad M, Rahman FN, Chowdhury MH, et al. Postmor- head injury which was also more common in most common victims of craniofacial trauma. Road Benzer A, et al. Traumatic intracranial haemorrhage in tem study of head injury in fatal road: traffic accidents. 21,24 patients with fracture of the upper face moreover traffic accidents were responsible for the majority and conscious patients with facial fractures-a review of 1959 JAFMC.2009; 5 :(2):24-28. loss of consciousness is less common with isolated most of the patients sustained moderate head injuries cases. Craniomaxillofac Surg. 2008;36:372-7. facial fractures. Gwynn et al found that life threaten- that were then managed conservatively. Fracture 21. Pradeep G, Ankit J, Nirmal K G. Association of Head ing injuries such as cerebral concussion were mandible was the most common maxillofacial injury 7. Adeyemo WL, Ladeinde AL, Ogunlewe MO, James injury and Maxillofacial Trauma: A prospective Case- frequently associated with facial fractures26 which .More severe were the maxillofacial injury more were O.Trends and characteristics of oral and maxillofacial Control study. Indian journal of Applied Research. 2016; support the result of our study. We found that 35% the chances of neurological injury. Fracture of the injuries in Nigeria: a review of the literature. Head Face 6(3): 528-531. Med. 2005; 1:7. patient had cerebral contusion. But at the same time, mid-face was found to be most commonly associated 22.Malara P, Malara B et al:characteristics of maxillofacial as in present series, all patients who sustain moder- with head injury and the management of both neuro- 8. Van Hoof RF, Merkx CA, Stekelenburg SC. The different trauma resulting from road traffic accidents- a 5years ate or severe head injury also, had associated intrac- logical and maxillofacial injury was done according to patterns of fractures of the facial skeleton in four European review. Head and Face medicine. 2006:2:27. ranial injuries reflecting the severity and complexity of the necessity. countries. Int J Oral Surg.1977; 6 (1): 3-11. craniofacial trauma.18 23.Obuekwe ON, Ojo MA, Akpata O. Maxillofacial trauma Apart from maxillofacial fractures, high velocity Recommendations: 9. Brown RD. Cowpe JG. Patterns of maxillofacial trauma in due to road traffic accidents in Benin City, Nigeria: A impacts may result in ruptures of intracranial vessels, In view of the high association of closed head injury in two different cultures: Acomparison:between Riyad and prospective study. Annals of African Medicine. 2003; 2(2): leading to life-threatening intracranial hemorrhage, the facial fracture population, as well as high potenti- Tayside. JR Coil surg Edinb.1985; 30(5): 299-302. 58-63. Intracranial hemorrhage was found in 45% cases in ality for mortality and neurological morbidity the present study, which was more as compared to previ- 10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture 24. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A authors of present study recommend the routine use patterns: A suburban trauma center experience. An J review of 100 closed head injuriesassociated with facial ous studies28.This may be due to the difference in the of head CT for all patients sustaining a facial trauma Otolaryngol. 2004; 25 (5): 301-307. fractures. J Oral Maxillofac Surg. 1992;50:218-22. mode and severity of injuries. and close monitoring of neurological status of these About intracranial lesions most of the victims had patients. 11. Ansari MH. Maxillofacial fractures in Hamedan provi- 25. Chowdhury D. Depressed skull fractures: analysis of subdural haemorrhage 18.3%, followed by extradural ence, Iran: A retrospective study (1987-2001). J Cranio- clinical outcome and cost effectiveness of timely surgical haemorrhage (15%), and subarachnoid haemor- Consent for the study maxilloac Surg.2004; 32 (I): 28-32. management. MS (Neurosurgery) thesis, BSMMU, 2002. rhage (11.7%). In a study from India by Ashok KG et • All patients or relatives were given a necessary 12. Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. 26. Gwynn P, Carraway JH, Horton CE, et al: Facial al, showed that 5% victims had subdural haemor- explanation about the study before they asked to Characteristics of associated trauma in patients with head fractures-associated injuries and complications. Plast and rhage 14% had subarachnoid haemorrhage and 13% participate. had extradural haemorrhage14 which is identical to injuries: An experience with 100 cases. J Trauma and Reconstr Surg. 1971; 47: 225-230. • For those patients who were unconscious, consents Shock. 2009; 2(2): 89-94. our study. were obtained from their relatives. 27. Pappachan B,Alexander M. Correlating facial fractures The results of previous studied evaluating the • For patients under ages 18 years, informed 13. Adekeye SO. The pattern of fracture of facial skeleton in and Cranial Injuries. J Oral Maxillofacial Surg. 2006; relationship between facial and head injuries are consents were obtained from their parents/ guardi- Kaduna Nigeria. A survey of 1447 cases. Oral Surg. 1980; 64:1023-1029. conflicting. Hohlrieder et al reported that Le Fort- ll ans. 49(6): 491- 495. and lll, Orbit, Nose,, Zygoma and Maxillary fractures 14. Ashok KG, Ran’ineesh G, Asish C. A retrospective 28. Zandi M, HoseiniSR. The relationship between head were associated with a 2-to 4 fold risk of intracranial analysis of 189 patients of maxillofacial injuries presenting injury and facial trauma: a case- control study. J oral and References: to a tertiary care hospital in Punjab, India. J Maxillofac Oral maxillofacial surgery. 2013; 7(3):201-207. hemorrhage, while mandibular fracture did not signifi- 1. Sharmin FN, Cameron P et al. Maxillofacial trauma in Burg. 2009; Sep;8(3):241-5. cantly increases the chance of intracranial hemor- major trauma patients. Aus Den Journ. 2006; rhage21. Haug et al. reported that although the mandi- 51(3):225-230. 15. Haug RH, Foss J. Maxillofacial injuries in the pediatric ble was the most frequent fractured bone in patients patient. Oral Surg Oral Med Oral Pathol of Oral Radio 2. Follmar KE, Debruijn M, Baccarant A, Bruno AD, Muku- with concomitant facial and head injuries, midface Endod. 2000; 90:126-134. fractures were more frequently associated with ndan S, Erdmann D et al Concomitantinjuries in patients relationship with the help of interocclusal recording ring that fits around the borders acts as a mold for the metallic die and were copied in the samples during Table-I: Distribution of horizontal distance in group A materials. These materials should have good dimen- impression material. The thickness of ring was 0.3 cm their fabrication. sional stability to achieve proper articulation4. Many and the diameter of the ring was 3cm. Therefore the The distance between the two reference points of materials are available for interocclusal record. These stainless steel die include stainless steel ring and each sample (A1_C1, and A2_C2) were measured by include: Bite registration wax (Aluwax, HiFi, base- stainless steel test block. The distance between the a traveling micrometer microscope. It had a millimeter plate), zinc-oxide eugenol paste, Addition silicone two parallel reference lines A and C was measured at scale and a vernier scale which were attached (polyvinylsiloxane), Polyether elastomer, Impression two fixed points. These reference points were scribed together and with the help of vernier scale it was compound, Impression plaster of paris, Acrylic resin, in the metallic die and were copied in the sample possible to measure up to 10 micrometer i.e. 0.01 Thermoplastic resin, Alginate (irreversible hydrocol- during their fabrication. millimeter. The two reference points between the loid), Condensation type silicone, Eugenol free zinc For polyvinylsiloxane specimen: vertical parallel line were measured through a magni- oxide eugenol paste4,5,6. Intercclusal recording mate- Two equal length of base and catalyst according to fying tube attached with the traveling micrometer rials are basically similar to impression materials but the manufacturers recommendation and kneaded microscope. At first reference point A1 was placed GroupA: polyvinylsiloxane; n:Total number of sample are modified to give good handing characteristics4. with clean finger instead of wearing latex gloves to beneath the magnifying tube on the platform of the Table-I shows that mean±SD was 6.00±0.00 after Each of these has advantages and disadvantages as prevent sulfur contamination from these gloves which microscope. The measurement M1 was recorded by one hour follow up visit 5.97±0.38 after 24 hours, interocclusal recording materials. In Bangladesh inhibits the setting of the addition silicone interocclu- the following formula. M1= (Reading of millimeter 5.92±0.04 after 48 hours and 5.82±0.04 after 72 most popular interocclusal recording materials are sal recoding material and may produced major distor- scale + Reading of vernier scale x vernier constant i.e hours follow up visit. It was indicated that maximum alginate5. Alginate has limitation but it also has some tion. Then kneaded material together (approximately 0.01) mm. Then the platform was horizontally moved horizontal distance between A & C after one hour advantages too over the other materials that make it 45 seconds) until a uniform, streak free color was without shifting the sample and with the help of rotat- follow up visit and minimum horizontal distance more valuable. Because of its extreme fluidity before achieved. It was then placed on the surface of the die ing the platform screw. Now reference point C1 was between A & C after 72 hours follow up visits. setting and its resilency after setting, alginate causes for impression making. fixed under the magnifying tube. The measurement Table II: Distribution horizontal distance in different minimal tooth and tissue displacement when occlusal For alginate specimen: M2 was measured by the same formula. Measure- follow up of group B registrations are made with it5. Posselt thought that For mixing alginate powder and water were meas- ment of the distance between A & C parallel lines at alginate records were superior to wax, but shrinkage ured according to the manufacturer’s recommenda- reference point between A1C1 is done by subtracting made them useless after a few minutes7. The dimen- tion at room temperature. The measured powder M1 from M2. So A1C1=M2-M1. In the same way, sional stability of interocclusal recording materials (9gm) was shifted into premeasured water (17ml) that horizontal distance between A2_C2 was measured. over time is of utmost importance, as it ensures a had already been poured into a clean rubber bowl. The mean of two readings were used for calculation more accurate representation of the patient's maxillo- The powder was incorporated into the water by care- for each sample. Reading was recorded for all 10 mandibular relationship10. So the study was done to fully mixing. Mixing time (30 seconds) was carefully samples of each group at intervals of 1 h, 24h, 48h & compare the dimensional stability of polyvinylsilox- maintained and after that it was placed on the surface 72 hours. The measurement data was collected from ane and alginate at various times of intervals (1h, 24 of the die for impression making. samples of each group and was recorded in data hs, 48 hs, 72 hs). Sample collection: collection sheet. Horizontal linear distance between Group B : Alginate; n:Total number of sample After homogenous mixing, the materials were carried A1 C1 and A2 C2 is measured in millimeters. Table-II shows that mean±SD was 5.68±0.05 after Materials & Methods to the die. The stainless steel die was inverted on to a Statistical analysis: one hour follow up visit, 5.56±0.02 after 24 hours, Introduction lation. In these situations, the patients’ interocclusal This comparative in vitro study was carried out 4x4 inch square glass plate covered with polyethyl- Data analysis was done by using computer based 5.49±0.03 after 48 hours and 5.41±0.06 after 72 Inter occlusal records are the means whereby inter records are made and sent along with the cast to the Department of Prosthodontics, BSMMU, Dhaka, from ene sheet. Hand pressure was applied for about five program SPSS (Statistical Package for Social hours follow up visit. It was indicated that maximum arch relationship are transferred from mouth to an laboratory. This requires that the records must be June 2009 to 2010. Duplicated disk of polyvinylsilox- seconds initially to express the materials followed by Sciences) version 12. Paired t test was done to find horizontal distance after one hour follow up visits and articulator1. Maxillomandibular records are necessary dimensionally stable for the given period of time ane and alginate obtained from custom made stain- application of a 500 g weight to further remove of out statistical significance value. The results were minimum after 72 hours follow up visits. 2 to study the status of the dentition and to construct before they are used to articulate the casts . Record- less steel die were used as a sample. The sample excess materials. Each assembly remains for the presented in tables and figures. The result of signifi- Table III: Comparison of horizontal distance in group dental restoration. One type of record is used for ing maxillomandibular relationship is an important size of the study was twenty. Only freshly prepared manufacturer suggested setting time ie alginate for 2 cance was expressed as p value. P value <0.05 was A and group B mounting casts of the teeth or setting the articulator step in oral rehabilitation. This relationship is trans- duplicated disks from die were selected. minutes 20 seconds and additional three minutes to considered as significant. adjustments and another for appraising the degree of ferred to the articulator so laboratory procedure done Group of sample: ensure polymerization of materials. The mold assem- occlusal or incisal tooth contacts2. Adequate laborato- on the cast will be corresponding with patients’ Group A: 10 disks were made with polyvinylsiloxane. bly was removed from the stainless steel die and all Results 3 ry facilities are commonly not available locally and mouth . To create a harmonious occlusion, it is Group B: 10 disks were made with alginate. excess materials were trimmed. Samples were stored The present in vitro study was intended to compare casts have to be sent to others laboratories for articu- essential to record the existing maxillomandibular Preparations of stainless steel die: in room temperature. Later specimens were prepared the dimensional stability of polyvinylsiloxane and The stainless steel die had two portions: a round in the form of a disk measuring 3cm in diameter with alginate at various times of intervals. Total 20 sam- stainless steel test block and a stainless steel ring4 three parallel lines on the surface. ples were evaluated. The findings of the study that fits around the borders and acts as a mold for the Measurement of the test samples: obtained were analyzed and presented below. specimen. A round stainless steel die was construct- These three lines were named A, B & C which were ed for testing dimensional change. Three parallel equally separated by a distance of 3 mm. The lines were included on the die surface. These three distance between the two parallel reference lines, A & C, were measured at two fixed points (A1C1 and Group A polyvinylsiloxane, Group B Alginate, The mean lines were named A, B and C which were equally difference is considered significant if p< 0.05. * Significant separated by a distance 3 mm. The stainless steel A2C2). These reference points were scribed in the

Update Dental College Journal Vol. 7 No. 1 | April 2017

Table-III shows that after 1 hour follow up visit Conclusion (RTC) were the most frequent cause of facial energy trauma causing maxillofacial injury are high the Oral and Maxillofacial surgery Department. Figure 1: Sex distribution of the patients (n=60) Table 3: Distribution of fracture facial bones (n=60) Table-5: Cross tabulation between pattern of facial 8.09:112. This indicates that males are more prone to beaten by her male partner and/or family members mean±SD was 6.00±0.00 in group A and mean±SD In this study we concluded that dimensional stability injuries7,8 However more recent studies have shown enough to cause concomitant head injury1,2,3,4. The fracture and severity of head injury (n-60) maxillofacial injury with or without head injury this for dowry for other reasons. We found only 1.7% in was 5.68±0.05 in group B. After 24 hours follow up is influenced by both Material and time factors. It that assault is now the most common cause of maxil- purpose of this study was to evaluate the pattern of Statistical analysis high vulnerability of male gender for all type of trauma our study. visit mean±SD was 5.97±0.08 in group A and decreased as the time factor is increased. Polyvinyl- lofacial injuries in developed countries9,10 where as head injuries in Patients with maxillofacial trauma and After the patient had given consent to be included in can be attributed to the fact that in our society males Isolated mandible fractures are most common facial mean±SD was 5.56±0.02 in group B. After 48 hours siloxane were dimensionally more stable than traffic accidents remain the most frequent cause in to co relate the relationship between them. the study, a standardized structured data collection are predominantly the bread bearing for the family. bone to be fractured ranging from 12.9% to as high as follow up visit mean±SD was 5.92±0.04 in group A alginate interocclusal material. many developing countries11 like Bangladesh. Others sheet was used to collect necessary information of Moreover they are at higher risk of injuries than 72.9%, followed by midface ranging from 25.9% to and mean±SD was 5.49±0.03 in group B. After 72 causes of maxillofacial trauma are fall from height, Material and methods: the study subject. The data were screened and women because of their greater exposure of automo- 29.5%11,12,21 the other frequently affected bones are hours follow up visit mean±SD was 5.82±0.04 in References assaults, altercation, pedestrian injury, home and This was a descriptive type of cross-sectional study checked for any missing value and discrepancy. The bile and motorcycle accident and engaged in more the floor of the orbit and nasal bones. However, in the group A and mean±SD was 5.41±0.06 in group B. industrial accidents and athletic injuries, in descend- carried out at the department of Oral & Maxillofacial data were then processed and analyzed using statis- risky behavior like hanging on the side of the bus or present series, the most frequent maxillofacial injury 12 The difference was statistically significant (P<0.05) 1. Skurnik H. Resin registration for interocclusal recods. J ing order of frequency . Surgery, Bangabondhu Sheikh Mujib Medical Univer- tical software SPSS (statistical Package for Social rush to get in a running bus. represented was the fractured mandible 36.6%, between group A and group B in different follow up ProsthetDent.1977;21(2):164-170. The peak age of incidence of maxillofacial injuries sity, Shahbag, Dhaka. The period of study was from Science) version16. Chi- square test was carried out In our study, it was found that majority of patients followed by fractured Zygomatico-maxillary complex visits. among 21 -30 years13 and more males are involved in 1st May 2010 to 30th April 2011. The patient’s data and significant level p value of < 0.05 was considered were in the age group between 2nd to 4th decade including orbit and Lefort fractures. In a survey by 2. Dua MP, Gupta SH, Ramachandran S, Sandhu HS. maxillofacial injuries than females14. Children are were collected from Inpatient department of Neuro- statistically significant. The summarized data were and mean age was 29.63 years which is similar to Malara P et ai in 2006, they found in 198 patients that Fig-1: Shows that among patients with both maxillofacial Discussion Evaluation for four elastomeric interocclusal recoding mate- uniquely susceptible to maxillofacial injury because of surgery, Dhaka Medical College &Hospital and inpa- present in the form of tables, graphs and bar other studies of the globe.21 The possible explanation 18.69%suffered mandibular fracture, 12.63% Zygo- rials. MJAFIl. 2007 ;63 (3) : 237-240. 15 and head injury 88.3% were male and 11.7% were female. The linear dimensional changes of two interocclusal their disproportionate cranial-body mass ratio . tient department of Oral and Maxillofacial Surgery, diagrams by the help of statistician. S = Significant for this is that the people in this age group take part in matic complex fracture and 12.2% maxillary Patients older than 65 years account for approxi- dangerous exercise and sports, drive motor vehicles fractures22. Obuekwe and Etetafia in 2004 found in recording materials were measured over time in this 3. Tripodakis AP, Vergos VK, Tsoutsos AG. Evaluation of Bangabondhu Sheikh Mujib Medical University, Table 2: Distribution of mode of injury (n=60) Table-3: Shows mandible was the most commonly Table-5: indicates that most of the zygomatic- maxillary study. These measurements provided an indication of the accuracy of interocclusal records in relation to two mately 1% of maxillofacial trauma, and falls on a Shahbag, Dhaka who were referred from other Results and Observation: fractured facial bone (36.67%) (n=22) at different anatomi- complex fracture including orbit occurred in case of moder- carelessly and are more likely to be involved in their study, that mandible was the most common site the dimensional stability of those materials. However, recording techniques. J Prosthet Dent.1997; 77 (2): slippery ground is the most common cause in this age Neurosurgical center. The total of 60 patients who cal locations. Both Zygomatico-maxillary complex fracture ate head injury and most of the Lefort-II fracture occurred in violence. Patients less than 10 years and more than of fracture, followed by Zygomatic complex and max- 16 23 dimensional stability can also be studied in all the 141-146. group . sustained both cranial and facial injuries were includ- Table-1: Age distribution of the study subjects (n=60) and Lefort-II fracture were equal frequency 18.3% (n=11). patients with moderate and severe head injury. And most of 60 years were less frequently affected in our series. illa . The results of our study therefore correlate with three planes using equipments like the condymeter, It was evident that the facial bones fractures were ed in this study. After taking informed consent, data the Lefort-III fracture occurred in patient with severe head These could be explained that children are usually other literatures. computerized Axitron and Buhnergraph4. Table 1 4. Karithikeyan K, Annapumi. Comparative evaluation of uncommonly singular with compound and comminut- were collected by history, through clinical examina- Table-4: Distribution of involvement of cranium (n=60) injury. taken care of by elders during travelling and lesser In this study we found among LeFort fractures shows group A exhibited no significant difference dimensional stability of three types of interocclusal record- ed nature adding on to the complexity of facial tion, radiographic evaluation and Neurosurgical mobility of geriatric people. But the effect of head LeFort- ll is more common (18.3%), than LeFort lll Graph 3: Correlation between pattern of facial fracture between the die scribe and those of the sample at the ing materials: an in vitro study. Journal of Indian Prostho- fractures. It is a common concept of fracture nasal consultation. Appropriate skull X-Rays were done in injury is disproportionately severe in elderly and they (11.7%) and LeFort – l. The pattern is identical to dontic Society.2007; 7(1) :24-27. and severity of head injury 15 immediate reading. Nisan et al2 observed that addi- bone being the most common facial bone to be all patients and patients with impaired conscious- require more neurosurgical care. studies conducted by Haug HR, Foss J. in 2000 . tion type silicone, polyvinyl siloxane is most accurate fractured, then the zygoma followed by mandible and ness, neurological sign or clinical sign of basal skull The main causes of craniofacial injury worldwide are Our results demonstrated lower incidence of Nasal 5. Scott WR .Occlusal registration using alginate (irreversi- 17 and stable interocclusal recording material. Table II ble hydrocolloid) impression material.J Prosthet Dent. maxilla. fracture, an initial CT scan was also performed. assaults and road traffic accidents, but the preva- bone fracture (5%), although it is a common concept shows in group B the same result. Table III shows 1978;40(5) :51 7-519. Apart from maxillofacial injury, high velocity impacts Information regarding age, gender, cause of injury, lence varies depending on the demographics and of fracture Nasal bone is the most frequent facial comparison of horizontal distance between group A may result in fracture of facial bones and life threaten- pattern of facial and/or head injuries, loss of geography of the area. Road traffic accidents (RTA) bone to be fractured. It probably comes from the fact and group B. The difference was statistically signifi- 6. Lassila V. Comparison of five interocclusal recording ing intracranial hemorrhages in different compart- consciousness, and GCS score were obtained and Table 2: indicates that majority of the victims suffered by are the commonest cause of craniofacial trauma in that isolated Nose fracture was managed by other cant (p<0.05) of all follow up visit between group A material. J Prosthet Dent.1986 ; 5: 215-218. ments requiring urgent neurosurgical intervention19. A recorded in questionnaires. motor vehicle accidents (60%), (n=36) followed by fall from most of the series5,11,12,20 and this occurred largely in specialties like ENT and Plastic Surgery. height (13.3%) (n=8) and pedestrians (11.7%), (n=7). and group B. Above reports showed similar results8. decrease in the level of consciousness is the single The causes of injury were summarized as follows: our circumstance also (60%) because of reckless- GCS is a good marker for determining potential brain Some researchers carried out an experimental9 study 7. Eriksson A, Eriksson GO, Lockowandt P, et al .Materials most reliable indicator that the patient has a serious Motor vehicle accidents, Fall from height, Pedestrian, ness and negligence of the drivers, poor mainte- injury, clinical conditions and prognosis of the patients for reliable interocclusal measurements. Br Dent J.2002 20 Graph 2: Distribution of Glasgow Coma Score (GCS) 24 and found that addition silicone presented smaller head injury or secondary insult to the brain . Loss of Assault, Sports injuries, Work-related injuries, and Mean ± SD = 29.63±12.0 Range = (5 - 64 years) nance of vehicles, often driving under the influence of following trauma . On the basis of GCS scores of the ;192 (7) : 385-400. intracranial hemorrhages, closed head traumas Majority of the victims were in the age group of 21 to of the patients (n=60) linear when compared to alginate. Moisture, especial- Introduction: consciousness is the manifestation of intracranial others. Table- 4: indicate that Linear fracture were more (31.6%) alcohol or drugs and complete disregard of traffic patients, It was found that, majority of patients with Maxillofacial trauma and concomitant head injuries (brain contusion or laceration), or fractures. General- 40 years (75%), with 21-30 years (51.7%) more ly, can cause considerable dimensional changes in 8. Lassila V, McCabe JF. Properties of interocclusal regis- injury or concussion head injury (62%), followed by Facial injuries included facial bone fractures and/or (n=19) then depressed fracture (n=16) and scalp injury. laws. Fall from height was the second most common head injury according to their GCS score were classi- carry the significant potential for mortality and neuro- ly, the presence of emesis, vomiting, loss of affected among this group. Children less than 10 yrs alginate. Therefore great care is taken wrapping and tration materials.J Prosthet Dent. 1985; 53: 100-104. headache (33%), vomiting (27%), nasal bleed (30%) soft tissue injuries. Facial bone fractures were classi- Discussion: cause of injury in our series and attributed to 13.3%, fied as having moderate head injury 55% (n=33), consciousness, or a low Glasgow Coma Scale (GCS) 21 and elderly >60yrs of age made up a less frequency. packaging them during storage and transfer. Few logical morbidity. Maxillofacial trauma can occur as and oral bleed (10%) . fied as mandibular, Lefort I, Lefort II, Lefort III, Zygo- Figure-2: Distribution of type of head injury (n=60) Bangladesh is a south Asian developing country this occurred mostly in urban area where lot of followed by severe head injury 20% (n=12),mild head score are important findings for suspicion of a cranial authors have suggested ideal times for articulation of 9. John J, Manapallil. Basic Dental Materials. 2nd ed .New an isolated injury or in combination with other severe The Glasgow Coma Scale score(GCS) is used to matico-maxillary fracture including orbit, and Nasal where poverty and unemployment forcing the people peoples worked as a day labour in construction of injury 15% (n=9), and minor head injury 10% (n=6) 1 injury. However, in patients with maxillofacial trauma, Graph 1: Age Distribution of the study subject (n=60) casts with respect to the type of interocclusal records Delhi: Jaypee Brothers medical publishers (p). Ltd.2003 : injuries . Patients with maxillofacial trauma may pres- quantify neurologic findings and it is widely accepted bone fractures. The types of mandibular fractures towards urban areas. This rapid and unplanned high rise buildings and painting them. It is in accord- respectively. The results from this study showed a head trauma may also be seen without observing the used. The result of this present study was consistent 58. ent with associated intracranial, pulmonary, intra-ab- and a standardized method for evaluating level of were classified by anatomic site (condyle, ramus, urbanization associated with incompetent traffic ance with others findings from South India, which significantly higher incidence of moderate type of 2,3 suggestive findings6. with the above study. Thus, it becomes mandatory to dominal or extremity injuries . A close relationship consciousness depending on the score of the GCS angle, body, symphysis, parasymphyses and coro- system, unplanned roads and highways, violation of reported 16,6% of Craniofacial trauma were due to head injuries associated with maxillofacial injuries as 10. Michalakis KX, Argiris P, Vassiliki A. Experimental The etiology of maxillofacial injuries varies from one 12 choose a material depending not only on the clinical between maxillofacial fracture and intracranial injury head injury can be classified as very mild, mild, mod- noid). traffic laws by the drivers and pedestrian injury, over- fall from coconut tree. In our study, we found, compared to other reports in the English literature. study on Particular Physical Properties of several Interoc- 4-6 country to another and even within the same depend- situation but also on the time taken for the articula- has been reported in many articles . In many coun- erate and severe head injury. About intracranial Head injuries included skull fractures and/or intracra- crowding, etc are responsible for highest figure of pedestrians constituted 11.7% of the total victims. In In case of head injury, various pattern of skull fracture clusal Recording Media. Part II: Linear Dimensional tries, cranial injury has been found to be the most ing on the prevailing socioeconomic, cultural and tion. From above study I found that dimensional Change and Accompanying Weight Change. Journal of lesions, contusion/ concussion, extradural hemato- nial injuries. Skull fractures were classified into scalp road traffic accidents, and these RTA victims are Dhaka city, a large number of pedestrians are were found. Linear fracture was the commonest type common accompanying organ injury in patients with environmental factors. Earlier studies from Europe changes of polyvinylsiloxane inter occlusal recording Prosthodontics. 2004 ;13(3) :150-159. ma, subdural hematoma, subarachnoid hematoma injury, linear fracture and depressed fracture of mainly suffered from Craniofacial injury. garments employees and day labor. They have lack (31.6%) followed by depressed fracture (26.6%). 3,4 and America revealed that Road Traffic crashes material was not significant in a horizontal plane after maxillofacial trauma . These includes head traumas, and intracerebral haematoma occurs most frequent- frontal, temporal, parietal, occipital, and basal skull Above figure indicates that most of the study population In the present study, majority of the head and of knowledge regarding traffic rules, shortage of Linear fracture was the commonest one because 20 1 and 24 hours. The changes after 48 and 72 hours ly . fractures. Intracranial injuries were summarized as suffered from moderate head injury (55%), (n=33), followed concomitant facial injuries were experienced by space in footpath, most of which are occupied by the during RTA head strikes by forcible contact with broad were lesser than other group. So it can be concluded Existing literature on the correlation of traumatic head concussion, cerebral contusion, and intracranial by severe head injury (20%) (n=12), mild head injury (15%), hawkers. Most of the pedestrians are not used to use resting surface like roads18. This result was identical (n=9) and very mild head injury (10%) (n=6). males, constituted 88.3% and females constituted that polyvinylsiloxane is more dimensionally stable injuries and maxillofacial trauma Is highly controver- hemorrhage (epidural, subdural, intracerebral and the pedestrian’s bridge. That’s why pedertrain injury to other study done by Ahmed et al in 2009 in Bang- Above figure indicates that, most of the study population only 11.7% of the total victims. The male to female sial. Some suggest that it is the facial skeleton that is a common cause of injury in our country. Domestic ladesh.20 Regarding depressed fracture of individual interocclusal recording materials than alginate. subarachnoid). Above graph indicates that 21-30 years age group was suffered from contussion (35%) (n=21). 18.3% had ratio was 7.57:1. These results are similar in a study absorbs the energy of the trauma, protecting the Brain trauma was handled by Neurosurgery depart- more commonly affected. subdural hemorrhage (n=11) and 15% had Extradural from India, where 89% of subjects were males and violence is another cause of craniofacial trauma in bones, Frontal was most prone to fracture (16.66%) brain from injury, whereas, others suggest that high ment and complex facial fractures were repaired by haemorrhage (n=9). 11% were females, giving a male to female ratio our country, where the women are most of the time followed by fracture temporal bone (5%) and parietal

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bone. This coincides with other study done previously closed head injuries than mandible fracture.19 These with panfacial fractures. J Trauma. 2007; 63:831-5. 16. Rehman K, Edmcndson H. The causes and conse- at BSMMU in Bangladesh in 2002.25 difference in the facial bone or head injury being stud- quences of maxillofacial injuries in elderly people. Gero- In agreement with a study by Pappachan and Alexan- ied and the variation in classification, nomenclature 3. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associ- dontology. 2002; 19:60-64. der, we observed that CSF rhinorrhoea was nearly or methodology of prior studies may explain these ated injuries in facial fractures: review of839 patients. Br J Plast Surg. 1993;46:635-8. 17. Khan AR, Arif S. Ear nose and throat injuries in children. twice as frequent as CSF otorrhoea.27 This may be conflicting result. In the present study we demonstrat- J Ayub Med Coll Abbottabad.2005; 17:54-6. explained by the fact that anterior Cranial base is ed that LeFort- lll fracture was the strongest predic- 4. Mulligan RP, Friedman JA, Mababir BC. A nationwide relatively closer to midfacial structures and has more tor of severe head injury, followed by LeFort- ll and review of the associations among cervical spine injuries, 18. Davidoff G, Jakubowski M, et al. The spectrum of sutural connection with midfacial bones compared to Zygomatico-maxillary fracture including Orbit this head injuries, and facial fractures. J Trauma. closed- head injuries in facial trauma victims:incidence and the middle cranial base. Thus, the chance of anterior coincide with the other findings done by Kloss et al. 2010;68:587-92. impact. Ann Emerg Med.1998; 17:6-9. cranial base fracture and resulting CSF rhinorrhoea is reported that LeFort- lll fracture was the strongest expected to be higher. predictor of intracranial bleeding. 5. Gwyn PP, Carraway JH, Horton CE, Adamson JE, 19. Egol R, Fromm KR, et al. Guideline for intensive care Similar to other studies the most common neurologi- Mladick BA. Facial fractures-associated injuries and unit admission, discharge, and triage. Cr/f Care Med 1992; complications. Plast Reconstr Surg. 1971;47:225-30. 27:633-638. cal symptom was loss of consciousness, which can Conclusion be manifestation of intracranial injury or concussion Adult males in the age group of 20-40 years were the 18,24 6. Kloss F, Laimer K, Hohlrieder M, Ulmer H, Hacki W, 20. Ahmad M, Rahman FN, Chowdhury MH, et al. Postmor- head injury which was also more common in most common victims of craniofacial trauma. Road Benzer A, et al. Traumatic intracranial haemorrhage in tem study of head injury in fatal road: traffic accidents. 21,24 patients with fracture of the upper face moreover traffic accidents were responsible for the majority and conscious patients with facial fractures-a review of 1959 JAFMC.2009; 5 :(2):24-28. loss of consciousness is less common with isolated most of the patients sustained moderate head injuries cases. Craniomaxillofac Surg. 2008;36:372-7. facial fractures. Gwynn et al found that life threaten- that were then managed conservatively. Fracture 21. Pradeep G, Ankit J, Nirmal K G. Association of Head ing injuries such as cerebral concussion were mandible was the most common maxillofacial injury 7. Adeyemo WL, Ladeinde AL, Ogunlewe MO, James injury and Maxillofacial Trauma: A prospective Case- frequently associated with facial fractures26 which .More severe were the maxillofacial injury more were O.Trends and characteristics of oral and maxillofacial Control study. Indian journal of Applied Research. 2016; support the result of our study. We found that 35% the chances of neurological injury. Fracture of the injuries in Nigeria: a review of the literature. Head Face 6(3): 528-531. Med. 2005; 1:7. patient had cerebral contusion. But at the same time, mid-face was found to be most commonly associated 22.Malara P, Malara B et al:characteristics of maxillofacial as in present series, all patients who sustain moder- with head injury and the management of both neuro- 8. Van Hoof RF, Merkx CA, Stekelenburg SC. The different trauma resulting from road traffic accidents- a 5years ate or severe head injury also, had associated intrac- logical and maxillofacial injury was done according to patterns of fractures of the facial skeleton in four European review. Head and Face medicine. 2006:2:27. ranial injuries reflecting the severity and complexity of the necessity. countries. Int J Oral Surg.1977; 6 (1): 3-11. craniofacial trauma.18 23.Obuekwe ON, Ojo MA, Akpata O. Maxillofacial trauma Apart from maxillofacial fractures, high velocity Recommendations: 9. Brown RD. Cowpe JG. Patterns of maxillofacial trauma in due to road traffic accidents in Benin City, Nigeria: A impacts may result in ruptures of intracranial vessels, In view of the high association of closed head injury in two different cultures: Acomparison:between Riyad and prospective study. Annals of African Medicine. 2003; 2(2): leading to life-threatening intracranial hemorrhage, the facial fracture population, as well as high potenti- Tayside. JR Coil surg Edinb.1985; 30(5): 299-302. 58-63. Intracranial hemorrhage was found in 45% cases in ality for mortality and neurological morbidity the present study, which was more as compared to previ- 10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture 24. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A authors of present study recommend the routine use patterns: A suburban trauma center experience. An J review of 100 closed head injuriesassociated with facial ous studies28.This may be due to the difference in the of head CT for all patients sustaining a facial trauma Otolaryngol. 2004; 25 (5): 301-307. fractures. J Oral Maxillofac Surg. 1992;50:218-22. mode and severity of injuries. and close monitoring of neurological status of these About intracranial lesions most of the victims had patients. 11. Ansari MH. Maxillofacial fractures in Hamedan provi- 25. Chowdhury D. Depressed skull fractures: analysis of subdural haemorrhage 18.3%, followed by extradural ence, Iran: A retrospective study (1987-2001). J Cranio- clinical outcome and cost effectiveness of timely surgical haemorrhage (15%), and subarachnoid haemor- Consent for the study maxilloac Surg.2004; 32 (I): 28-32. management. MS (Neurosurgery) thesis, BSMMU, 2002. rhage (11.7%). In a study from India by Ashok KG et • All patients or relatives were given a necessary 12. Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. 26. Gwynn P, Carraway JH, Horton CE, et al: Facial al, showed that 5% victims had subdural haemor- explanation about the study before they asked to Characteristics of associated trauma in patients with head fractures-associated injuries and complications. Plast and rhage 14% had subarachnoid haemorrhage and 13% participate. had extradural haemorrhage14 which is identical to injuries: An experience with 100 cases. J Trauma and Reconstr Surg. 1971; 47: 225-230. • For those patients who were unconscious, consents Shock. 2009; 2(2): 89-94. our study. were obtained from their relatives. 27. Pappachan B,Alexander M. Correlating facial fractures The results of previous studied evaluating the • For patients under ages 18 years, informed 13. Adekeye SO. The pattern of fracture of facial skeleton in and Cranial Injuries. J Oral Maxillofacial Surg. 2006; relationship between facial and head injuries are consents were obtained from their parents/ guardi- Kaduna Nigeria. A survey of 1447 cases. Oral Surg. 1980; 64:1023-1029. conflicting. Hohlrieder et al reported that Le Fort- ll ans. 49(6): 491- 495. and lll, Orbit, Nose,, Zygoma and Maxillary fractures 14. Ashok KG, Ran’ineesh G, Asish C. A retrospective 28. Zandi M, HoseiniSR. The relationship between head were associated with a 2-to 4 fold risk of intracranial analysis of 189 patients of maxillofacial injuries presenting injury and facial trauma: a case- control study. J oral and References: to a tertiary care hospital in Punjab, India. J Maxillofac Oral maxillofacial surgery. 2013; 7(3):201-207. hemorrhage, while mandibular fracture did not signifi- 1. Sharmin FN, Cameron P et al. Maxillofacial trauma in Burg. 2009; Sep;8(3):241-5. cantly increases the chance of intracranial hemor- major trauma patients. Aus Den Journ. 2006; rhage21. Haug et al. reported that although the mandi- 51(3):225-230. 15. Haug RH, Foss J. Maxillofacial injuries in the pediatric ble was the most frequent fractured bone in patients patient. Oral Surg Oral Med Oral Pathol of Oral Radio 2. Follmar KE, Debruijn M, Baccarant A, Bruno AD, Muku- with concomitant facial and head injuries, midface Endod. 2000; 90:126-134. fractures were more frequently associated with ndan S, Erdmann D et al Concomitantinjuries in patients relationship with the help of interocclusal recording ring that fits around the borders acts as a mold for the metallic die and were copied in the samples during Table-I: Distribution of horizontal distance in group A materials. These materials should have good dimen- impression material. The thickness of ring was 0.3 cm their fabrication. sional stability to achieve proper articulation4. Many and the diameter of the ring was 3cm. Therefore the The distance between the two reference points of materials are available for interocclusal record. These stainless steel die include stainless steel ring and each sample (A1_C1, and A2_C2) were measured by include: Bite registration wax (Aluwax, HiFi, base- stainless steel test block. The distance between the a traveling micrometer microscope. It had a millimeter plate), zinc-oxide eugenol paste, Addition silicone two parallel reference lines A and C was measured at scale and a vernier scale which were attached (polyvinylsiloxane), Polyether elastomer, Impression two fixed points. These reference points were scribed together and with the help of vernier scale it was compound, Impression plaster of paris, Acrylic resin, in the metallic die and were copied in the sample possible to measure up to 10 micrometer i.e. 0.01 Thermoplastic resin, Alginate (irreversible hydrocol- during their fabrication. millimeter. The two reference points between the loid), Condensation type silicone, Eugenol free zinc For polyvinylsiloxane specimen: vertical parallel line were measured through a magni- oxide eugenol paste4,5,6. Intercclusal recording mate- Two equal length of base and catalyst according to fying tube attached with the traveling micrometer rials are basically similar to impression materials but the manufacturers recommendation and kneaded microscope. At first reference point A1 was placed GroupA: polyvinylsiloxane; n:Total number of sample are modified to give good handing characteristics4. with clean finger instead of wearing latex gloves to beneath the magnifying tube on the platform of the Table-I shows that mean±SD was 6.00±0.00 after Each of these has advantages and disadvantages as prevent sulfur contamination from these gloves which microscope. The measurement M1 was recorded by one hour follow up visit 5.97±0.38 after 24 hours, interocclusal recording materials. In Bangladesh inhibits the setting of the addition silicone interocclu- the following formula. M1= (Reading of millimeter 5.92±0.04 after 48 hours and 5.82±0.04 after 72 most popular interocclusal recording materials are sal recoding material and may produced major distor- scale + Reading of vernier scale x vernier constant i.e hours follow up visit. It was indicated that maximum alginate5. Alginate has limitation but it also has some tion. Then kneaded material together (approximately 0.01) mm. Then the platform was horizontally moved horizontal distance between A & C after one hour advantages too over the other materials that make it 45 seconds) until a uniform, streak free color was without shifting the sample and with the help of rotat- follow up visit and minimum horizontal distance more valuable. Because of its extreme fluidity before achieved. It was then placed on the surface of the die ing the platform screw. Now reference point C1 was between A & C after 72 hours follow up visits. setting and its resilency after setting, alginate causes for impression making. fixed under the magnifying tube. The measurement Table II: Distribution horizontal distance in different minimal tooth and tissue displacement when occlusal For alginate specimen: M2 was measured by the same formula. Measure- follow up of group B registrations are made with it5. Posselt thought that For mixing alginate powder and water were meas- ment of the distance between A & C parallel lines at alginate records were superior to wax, but shrinkage ured according to the manufacturer’s recommenda- reference point between A1C1 is done by subtracting made them useless after a few minutes7. The dimen- tion at room temperature. The measured powder M1 from M2. So A1C1=M2-M1. In the same way, sional stability of interocclusal recording materials (9gm) was shifted into premeasured water (17ml) that horizontal distance between A2_C2 was measured. over time is of utmost importance, as it ensures a had already been poured into a clean rubber bowl. The mean of two readings were used for calculation more accurate representation of the patient's maxillo- The powder was incorporated into the water by care- for each sample. Reading was recorded for all 10 mandibular relationship10. So the study was done to fully mixing. Mixing time (30 seconds) was carefully samples of each group at intervals of 1 h, 24h, 48h & compare the dimensional stability of polyvinylsilox- maintained and after that it was placed on the surface 72 hours. The measurement data was collected from ane and alginate at various times of intervals (1h, 24 of the die for impression making. samples of each group and was recorded in data hs, 48 hs, 72 hs). Sample collection: collection sheet. Horizontal linear distance between Group B : Alginate; n:Total number of sample After homogenous mixing, the materials were carried A1 C1 and A2 C2 is measured in millimeters. Table-II shows that mean±SD was 5.68±0.05 after Materials & Methods to the die. The stainless steel die was inverted on to a Statistical analysis: one hour follow up visit, 5.56±0.02 after 24 hours, Introduction lation. In these situations, the patients’ interocclusal This comparative in vitro study was carried out 4x4 inch square glass plate covered with polyethyl- Data analysis was done by using computer based 5.49±0.03 after 48 hours and 5.41±0.06 after 72 Inter occlusal records are the means whereby inter records are made and sent along with the cast to the Department of Prosthodontics, BSMMU, Dhaka, from ene sheet. Hand pressure was applied for about five program SPSS (Statistical Package for Social hours follow up visit. It was indicated that maximum arch relationship are transferred from mouth to an laboratory. This requires that the records must be June 2009 to 2010. Duplicated disk of polyvinylsilox- seconds initially to express the materials followed by Sciences) version 12. Paired t test was done to find horizontal distance after one hour follow up visits and articulator1. Maxillomandibular records are necessary dimensionally stable for the given period of time ane and alginate obtained from custom made stain- application of a 500 g weight to further remove of out statistical significance value. The results were minimum after 72 hours follow up visits. 2 to study the status of the dentition and to construct before they are used to articulate the casts . Record- less steel die were used as a sample. The sample excess materials. Each assembly remains for the presented in tables and figures. The result of signifi- Table III: Comparison of horizontal distance in group dental restoration. One type of record is used for ing maxillomandibular relationship is an important size of the study was twenty. Only freshly prepared manufacturer suggested setting time ie alginate for 2 cance was expressed as p value. P value <0.05 was A and group B mounting casts of the teeth or setting the articulator step in oral rehabilitation. This relationship is trans- duplicated disks from die were selected. minutes 20 seconds and additional three minutes to considered as significant. adjustments and another for appraising the degree of ferred to the articulator so laboratory procedure done Group of sample: ensure polymerization of materials. The mold assem- occlusal or incisal tooth contacts2. Adequate laborato- on the cast will be corresponding with patients’ Group A: 10 disks were made with polyvinylsiloxane. bly was removed from the stainless steel die and all Results 3 ry facilities are commonly not available locally and mouth . To create a harmonious occlusion, it is Group B: 10 disks were made with alginate. excess materials were trimmed. Samples were stored The present in vitro study was intended to compare casts have to be sent to others laboratories for articu- essential to record the existing maxillomandibular Preparations of stainless steel die: in room temperature. Later specimens were prepared the dimensional stability of polyvinylsiloxane and The stainless steel die had two portions: a round in the form of a disk measuring 3cm in diameter with alginate at various times of intervals. Total 20 sam- stainless steel test block and a stainless steel ring4 three parallel lines on the surface. ples were evaluated. The findings of the study that fits around the borders and acts as a mold for the Measurement of the test samples: obtained were analyzed and presented below. specimen. A round stainless steel die was construct- These three lines were named A, B & C which were ed for testing dimensional change. Three parallel equally separated by a distance of 3 mm. The lines were included on the die surface. These three distance between the two parallel reference lines, A & C, were measured at two fixed points (A1C1 and Group A polyvinylsiloxane, Group B Alginate, The mean lines were named A, B and C which were equally difference is considered significant if p< 0.05. * Significant separated by a distance 3 mm. The stainless steel A2C2). These reference points were scribed in the

Update Dental College Journal Vol. 7 No. 1 | April 2017

Table-III shows that after 1 hour follow up visit Conclusion (RTC) were the most frequent cause of facial energy trauma causing maxillofacial injury are high the Oral and Maxillofacial surgery Department. Figure 1: Sex distribution of the patients (n=60) Table 3: Distribution of fracture facial bones (n=60) Table-5: Cross tabulation between pattern of facial 8.09:112. This indicates that males are more prone to beaten by her male partner and/or family members mean±SD was 6.00±0.00 in group A and mean±SD In this study we concluded that dimensional stability injuries7,8 However more recent studies have shown enough to cause concomitant head injury1,2,3,4. The fracture and severity of head injury (n-60) maxillofacial injury with or without head injury this for dowry for other reasons. We found only 1.7% in was 5.68±0.05 in group B. After 24 hours follow up is influenced by both Material and time factors. It that assault is now the most common cause of maxil- purpose of this study was to evaluate the pattern of Statistical analysis high vulnerability of male gender for all type of trauma our study. visit mean±SD was 5.97±0.08 in group A and decreased as the time factor is increased. Polyvinyl- lofacial injuries in developed countries9,10 where as head injuries in Patients with maxillofacial trauma and After the patient had given consent to be included in can be attributed to the fact that in our society males Isolated mandible fractures are most common facial mean±SD was 5.56±0.02 in group B. After 48 hours siloxane were dimensionally more stable than traffic accidents remain the most frequent cause in to co relate the relationship between them. the study, a standardized structured data collection 11.7 are predominantly the bread bearing for the family. bone to be fractured ranging from 12.9% to as high as follow up visit mean±SD was 5.92±0.04 in group A alginate interocclusal material. many developing countries11 like Bangladesh. Others sheet was used to collect necessary information of Moreover they are at higher risk of injuries than 72.9%, followed by midface ranging from 25.9% to and mean±SD was 5.49±0.03 in group B. After 72 causes of maxillofacial trauma are fall from height, Material and methods: the study subject. The data were screened and Male women because of their greater exposure of automo- 29.5%11,12,21 the other frequently affected bones are Female hours follow up visit mean±SD was 5.82±0.04 in References assaults, altercation, pedestrian injury, home and This was a descriptive type of cross-sectional study checked for any missing value and discrepancy. The bile and motorcycle accident and engaged in more the floor of the orbit and nasal bones. However, in the group A and mean±SD was 5.41±0.06 in group B. industrial accidents and athletic injuries, in descend- carried out at the department of Oral & Maxillofacial data were then processed and analyzed using statis- risky behavior like hanging on the side of the bus or present series, the most frequent maxillofacial injury 12 88.3 The difference was statistically significant (P<0.05) 1. Skurnik H. Resin registration for interocclusal recods. J ing order of frequency . Surgery, Bangabondhu Sheikh Mujib Medical Univer- tical software SPSS (statistical Package for Social rush to get in a running bus. represented was the fractured mandible 36.6%, between group A and group B in different follow up ProsthetDent.1977;21(2):164-170. The peak age of incidence of maxillofacial injuries sity, Shahbag, Dhaka. The period of study was from Science) version16. Chi- square test was carried out In our study, it was found that majority of patients followed by fractured Zygomatico-maxillary complex visits. among 21 -30 years13 and more males are involved in 1st May 2010 to 30th April 2011. The patient’s data and significant level p value of < 0.05 was considered were in the age group between 2nd to 4th decade including orbit and Lefort fractures. In a survey by 2. Dua MP, Gupta SH, Ramachandran S, Sandhu HS. maxillofacial injuries than females14. Children are were collected from Inpatient department of Neuro- statistically significant. The summarized data were and mean age was 29.63 years which is similar to Malara P et ai in 2006, they found in 198 patients that Fig-1: Shows that among patients with both maxillofacial Discussion Evaluation for four elastomeric interocclusal recoding mate- uniquely susceptible to maxillofacial injury because of surgery, Dhaka Medical College &Hospital and inpa- present in the form of tables, graphs and bar other studies of the globe.21 The possible explanation 18.69%suffered mandibular fracture, 12.63% Zygo- rials. MJAFIl. 2007 ;63 (3) : 237-240. 15 and head injury 88.3% were male and 11.7% were female. The linear dimensional changes of two interocclusal their disproportionate cranial-body mass ratio . tient department of Oral and Maxillofacial Surgery, diagrams by the help of statistician. S = Significant for this is that the people in this age group take part in matic complex fracture and 12.2% maxillary Patients older than 65 years account for approxi- dangerous exercise and sports, drive motor vehicles fractures22. Obuekwe and Etetafia in 2004 found in recording materials were measured over time in this 3. Tripodakis AP, Vergos VK, Tsoutsos AG. Evaluation of Bangabondhu Sheikh Mujib Medical University, Table 2: Distribution of mode of injury (n=60) Table-3: Shows mandible was the most commonly Table-5: indicates that most of the zygomatic- maxillary study. These measurements provided an indication of mately 1% of maxillofacial trauma, and falls on a Shahbag, Dhaka who were referred from other fractured facial bone (36.67%) (n=22) at different anatomi- complex fracture including orbit occurred in case of moder- carelessly and are more likely to be involved in their study, that mandible was the most common site the accuracy of interocclusal records in relation to two Results and Observation: Number of the dimensional stability of those materials. However, recording techniques. J Prosthet Dent.1997; 77 (2): slippery ground is the most common cause in this age Neurosurgical center. The total of 60 patients who Mode of injury Percent cal locations. Both Zygomatico-maxillary complex fracture ate head injury and most of the Lefort-II fracture occurred in violence. Patients less than 10 years and more than of fracture, followed by Zygomatic complex and max- 16 patients 23 dimensional stability can also be studied in all the 141-146. group . sustained both cranial and facial injuries were includ- Table-1: Age distribution of the study subjects (n=60) and Lefort-II fracture were equal frequency 18.3% (n=11). patients with moderate and severe head injury. And most of 60 years were less frequently affected in our series. illa . The results of our study therefore correlate with three planes using equipments like the condymeter, It was evident that the facial bones fractures were ed in this study. After taking informed consent, data Motor vehicle 36 60.0 the Lefort-III fracture occurred in patient with severe head These could be explained that children are usually other literatures. computerized Axitron and Buhnergraph4. Table 1 4. Karithikeyan K, Annapumi. Comparative evaluation of uncommonly singular with compound and comminut- were collected by history, through clinical examina- Age group (in Number of Fall from height 8 13.3 Table-4: Distribution of involvement of cranium (n=60) injury. taken care of by elders during travelling and lesser In this study we found among LeFort fractures Percent shows group A exhibited no significant difference dimensional stability of three types of interocclusal record- ed nature adding on to the complexity of facial tion, radiographic evaluation and Neurosurgical years) patients Pedestrian injury 7 11.7 mobility of geriatric people. But the effect of head LeFort- ll is more common (18.3%), than LeFort lll Graph 3: Correlation between pattern of facial fracture ing materials: an in vitro study. Journal of Indian Prostho- fractures. It is a common concept of fracture nasal 0-10 3 5.0 Assault 5 8.3 injury is disproportionately severe in elderly and they (11.7%) and LeFort – l. The pattern is identical to between the die scribe and those of the sample at the consultation. Appropriate skull X-Rays were done in and severity of head injury 2 dontic Society.2007; 7(1) :24-27. 15 immediate reading. Nisan et al observed that addi- bone being the most common facial bone to be all patients and patients with impaired conscious- 11-20 5 8.3 Gunshot 1 1.7 require more neurosurgical care. studies conducted by Haug HR, Foss J. in 2000 . fractured, then the zygoma followed by mandible and The main causes of craniofacial injury worldwide are Our results demonstrated lower incidence of Nasal tion type silicone, polyvinyl siloxane is most accurate 5. Scott WR .Occlusal registration using alginate (irreversi- ness, neurological sign or clinical sign of basal skull 21-30 31 51.7 Sports 2 3.3 and stable interocclusal recording material. Table II maxilla.17 fracture, an initial CT scan was also performed. assaults and road traffic accidents, but the preva- bone fracture (5%), although it is a common concept ble hydrocolloid) impression material.J Prosthet Dent. 31-40 14 23.3 Domestic violence 1 1.7 shows in group B the same result. Table III shows Apart from maxillofacial injury, high velocity impacts Information regarding age, gender, cause of injury, lence varies depending on the demographics and of fracture Nasal bone is the most frequent facial 1978;40(5) :51 7-519. Total 60 100.0 comparison of horizontal distance between group A may result in fracture of facial bones and life threaten- pattern of facial and/or head injuries, loss of 41-50 3 5.0 geography of the area. Road traffic accidents (RTA) bone to be fractured. It probably comes from the fact and group B. The difference was statistically signifi- 6. Lassila V. Comparison of five interocclusal recording ing intracranial hemorrhages in different compart- consciousness, and GCS score were obtained and 51-60 2 3.3 Table 2: indicates that majority of the victims suffered by are the commonest cause of craniofacial trauma in that isolated Nose fracture was managed by other 19 motor vehicle accidents (60%), (n=36) followed by fall from 5,11,12,20 cant (p<0.05) of all follow up visit between group A material. J Prosthet Dent.1986 ; 5: 215-218. ments requiring urgent neurosurgical intervention . A recorded in questionnaires. 61-70 2 3.3 most of the series and this occurred largely in specialties like ENT and Plastic Surgery. 8 decrease in the level of consciousness is the single height (13.3%) (n=8) and pedestrians (11.7%), (n=7). our circumstance also (60%) because of reckless- GCS is a good marker for determining potential brain and group B. Above reports showed similar results . The causes of injury were summarized as follows: Total 60 100.0 Some researchers carried out an experimental9 study 7. Eriksson A, Eriksson GO, Lockowandt P, et al .Materials most reliable indicator that the patient has a serious Motor vehicle accidents, Fall from height, Pedestrian, ness and negligence of the drivers, poor mainte- injury, clinical conditions and prognosis of the patients for reliable interocclusal measurements. Br Dent J.2002 20 Graph 2: Distribution of Glasgow Coma Score (GCS) 24 and found that addition silicone presented smaller head injury or secondary insult to the brain . Loss of Assault, Sports injuries, Work-related injuries, and Mean ± SD = 29.63±12.0 Range = (5 - 64 years) nance of vehicles, often driving under the influence of following trauma . On the basis of GCS scores of the ;192 (7) : 385-400. intracranial hemorrhages, closed head traumas Majority of the victims were in the age group of 21 to of the patients (n=60) linear when compared to alginate. Moisture, especial- Introduction: consciousness is the manifestation of intracranial others. Table- 4: indicate that Linear fracture were more (31.6%) alcohol or drugs and complete disregard of traffic patients, It was found that, majority of patients with Maxillofacial trauma and concomitant head injuries (brain contusion or laceration), or fractures. General- injury or concussion head injury (62%), followed by 40 years (75%), with 21-30 years (51.7%) more laws. Fall from height was the second most common head injury according to their GCS score were classi- ly, can cause considerable dimensional changes in 8. Lassila V, McCabe JF. Properties of interocclusal regis- Facial injuries included facial bone fractures and/or 60 55 (n=19) then depressed fracture (n=16) and scalp injury. carry the significant potential for mortality and neuro- ly, the presence of emesis, vomiting, loss of affected among this group. Children less than 10 yrs alginate. Therefore great care is taken wrapping and tration materials.J Prosthet Dent. 1985; 53: 100-104. headache (33%), vomiting (27%), nasal bleed (30%) soft tissue injuries. Facial bone fractures were classi- Discussion: cause of injury in our series and attributed to 13.3%, fied as having moderate head injury 55% (n=33), consciousness, or a low Glasgow Coma Scale (GCS) 21 and elderly >60yrs of age made up a less frequency. 50 packaging them during storage and transfer. Few logical morbidity. Maxillofacial trauma can occur as and oral bleed (10%) . fied as mandibular, Lefort I, Lefort II, Lefort III, Zygo- ) Figure-2: Distribution of type of head injury (n=60) Bangladesh is a south Asian developing country this occurred mostly in urban area where lot of followed by severe head injury 20% (n=12),mild head %

( an isolated injury or in combination with other severe score are important findings for suspicion of a cranial 40 authors have suggested ideal times for articulation of 9. John J, Manapallil. Basic Dental Materials. 2nd ed .New The Glasgow Coma Scale score(GCS) is used to matico-maxillary fracture including orbit, and Nasal e where poverty and unemployment forcing the people peoples worked as a day labour in construction of injury 15% (n=9), and minor head injury 10% (n=6) 1 Graph 1: Age Distribution of the study subject (n=60) g injury. However, in patients with maxillofacial trauma, a casts with respect to the type of interocclusal records Delhi: Jaypee Brothers medical publishers (p). Ltd.2003 : injuries . Patients with maxillofacial trauma may pres- quantify neurologic findings and it is widely accepted bone fractures. The types of mandibular fractures t 30 20 high rise buildings and painting them. It is in accord- respectively. The results from this study showed a

n towards urban areas. This rapid and unplanned 58. head trauma may also be seen without observing the e ent with associated intracranial, pulmonary, intra-ab- and a standardized method for evaluating level of c 15 ance with others findings from South India, which significantly higher incidence of moderate type of used. The result of this present study was consistent were classified by anatomic site (condyle, ramus, 60 r 20 urbanization associated with incompetent traffic 2,3 6 e 10 suggestive findings . P with the above study. Thus, it becomes mandatory to dominal or extremity injuries . A close relationship consciousness depending on the score of the GCS angle, body, symphysis, parasymphyses and coro- 51.7 system, unplanned roads and highways, violation of reported 16,6% of Craniofacial trauma were due to head injuries associated with maxillofacial injuries as 10. Michalakis KX, Argiris P, Vassiliki A. Experimental 50 10 12 between maxillofacial fracture and intracranial injury The etiology of maxillofacial injuries varies from one head injury can be classified as very mild, mild, mod- ) fall from coconut tree. In our study, we found, compared to other reports in the English literature.

choose a material depending not only on the clinical noid). %

( traffic laws by the drivers and pedestrian injury, over- study on Particular Physical Properties of several Interoc- 4-6 40 has been reported in many articles . In many coun- country to another and even within the same depend- e 0 situation but also on the time taken for the articula- erate and severe head injury. About intracranial Head injuries included skull fractures and/or intracra- g pedestrians constituted 11.7% of the total victims. In In case of head injury, various pattern of skull fracture a Very mild Mild Moderate Severe crowding, etc are responsible for highest figure of clusal Recording Media. Part II: Linear Dimensional t 30 tries, cranial injury has been found to be the most ing on the prevailing socioeconomic, cultural and n tion. From above study I found that dimensional lesions, contusion/ concussion, extradural hemato- nial injuries. Skull fractures were classified into scalp e 23.3 Dhaka city, a large number of pedestrians are were found. Linear fracture was the commonest type c GCS stage road traffic accidents, and these RTA victims are Change and Accompanying Weight Change. Journal of r 20 common accompanying organ injury in patients with environmental factors. Earlier studies from Europe e changes of polyvinylsiloxane inter occlusal recording ma, subdural hematoma, subarachnoid hematoma injury, linear fracture and depressed fracture of P garments employees and day labor. They have lack (31.6%) followed by depressed fracture (26.6%). Prosthodontics. 2004 ;13(3) :150-159. 3,4 8.3 mainly suffered from Craniofacial injury. maxillofacial trauma . These includes head traumas, and America revealed that Road Traffic crashes 10 5 5 material was not significant in a horizontal plane after and intracerebral haematoma occurs most frequent- frontal, temporal, parietal, occipital, and basal skull 3.3 3.3 Above figure indicates that most of the study population In the present study, majority of the head and of knowledge regarding traffic rules, shortage of Linear fracture was the commonest one because 20 0 suffered from moderate head injury (55%), (n=33), followed 1 and 24 hours. The changes after 48 and 72 hours ly . fractures. Intracranial injuries were summarized as 0-10 11-20. 21-30 31-40 41-50 51-60 61-70 concomitant facial injuries were experienced by space in footpath, most of which are occupied by the during RTA head strikes by forcible contact with broad by severe head injury (20%) (n=12), mild head injury (15%), 18 were lesser than other group. So it can be concluded Existing literature on the correlation of traumatic head concussion, cerebral contusion, and intracranial Age group hawkers. Most of the pedestrians are not used to use resting surface like roads . This result was identical (n=9) and very mild head injury (10%) (n=6). males, constituted 88.3% and females constituted that polyvinylsiloxane is more dimensionally stable injuries and maxillofacial trauma Is highly controver- hemorrhage (epidural, subdural, intracerebral and the pedestrian’s bridge. That’s why pedertrain injury to other study done by Ahmed et al in 2009 in Bang- Above figure indicates that, most of the study population only 11.7% of the total victims. The male to female sial. Some suggest that it is the facial skeleton that is a common cause of injury in our country. Domestic ladesh.20 Regarding depressed fracture of individual interocclusal recording materials than alginate. subarachnoid). Above graph indicates that 21-30 years age group was suffered from contussion (35%) (n=21). 18.3% had ratio was 7.57:1. These results are similar in a study absorbs the energy of the trauma, protecting the Brain trauma was handled by Neurosurgery depart- more commonly affected. subdural hemorrhage (n=11) and 15% had Extradural from India, where 89% of subjects were males and violence is another cause of craniofacial trauma in bones, Frontal was most prone to fracture (16.66%) brain from injury, whereas, others suggest that high ment and complex facial fractures were repaired by haemorrhage (n=9). 11% were females, giving a male to female ratio our country, where the women are most of the time followed by fracture temporal bone (5%) and parietal

16

bone. This coincides with other study done previously closed head injuries than mandible fracture.19 These with panfacial fractures. J Trauma. 2007; 63:831-5. 16. Rehman K, Edmcndson H. The causes and conse- at BSMMU in Bangladesh in 2002.25 difference in the facial bone or head injury being stud- quences of maxillofacial injuries in elderly people. Gero- In agreement with a study by Pappachan and Alexan- ied and the variation in classification, nomenclature 3. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associ- dontology. 2002; 19:60-64. der, we observed that CSF rhinorrhoea was nearly or methodology of prior studies may explain these ated injuries in facial fractures: review of839 patients. Br J Plast Surg. 1993;46:635-8. 17. Khan AR, Arif S. Ear nose and throat injuries in children. twice as frequent as CSF otorrhoea.27 This may be conflicting result. In the present study we demonstrat- J Ayub Med Coll Abbottabad.2005; 17:54-6. explained by the fact that anterior Cranial base is ed that LeFort- lll fracture was the strongest predic- 4. Mulligan RP, Friedman JA, Mababir BC. A nationwide relatively closer to midfacial structures and has more tor of severe head injury, followed by LeFort- ll and review of the associations among cervical spine injuries, 18. Davidoff G, Jakubowski M, et al. The spectrum of sutural connection with midfacial bones compared to Zygomatico-maxillary fracture including Orbit this head injuries, and facial fractures. J Trauma. closed- head injuries in facial trauma victims:incidence and the middle cranial base. Thus, the chance of anterior coincide with the other findings done by Kloss et al. 2010;68:587-92. impact. Ann Emerg Med.1998; 17:6-9. cranial base fracture and resulting CSF rhinorrhoea is reported that LeFort- lll fracture was the strongest expected to be higher. predictor of intracranial bleeding. 5. Gwyn PP, Carraway JH, Horton CE, Adamson JE, 19. Egol R, Fromm KR, et al. Guideline for intensive care Similar to other studies the most common neurologi- Mladick BA. Facial fractures-associated injuries and unit admission, discharge, and triage. Cr/f Care Med 1992; complications. Plast Reconstr Surg. 1971;47:225-30. 27:633-638. cal symptom was loss of consciousness, which can Conclusion be manifestation of intracranial injury or concussion Adult males in the age group of 20-40 years were the 18,24 6. Kloss F, Laimer K, Hohlrieder M, Ulmer H, Hacki W, 20. Ahmad M, Rahman FN, Chowdhury MH, et al. Postmor- head injury which was also more common in most common victims of craniofacial trauma. Road Benzer A, et al. Traumatic intracranial haemorrhage in tem study of head injury in fatal road: traffic accidents. 21,24 patients with fracture of the upper face moreover traffic accidents were responsible for the majority and conscious patients with facial fractures-a review of 1959 JAFMC.2009; 5 :(2):24-28. loss of consciousness is less common with isolated most of the patients sustained moderate head injuries cases. Craniomaxillofac Surg. 2008;36:372-7. facial fractures. Gwynn et al found that life threaten- that were then managed conservatively. Fracture 21. Pradeep G, Ankit J, Nirmal K G. Association of Head ing injuries such as cerebral concussion were mandible was the most common maxillofacial injury 7. Adeyemo WL, Ladeinde AL, Ogunlewe MO, James injury and Maxillofacial Trauma: A prospective Case- frequently associated with facial fractures26 which .More severe were the maxillofacial injury more were O.Trends and characteristics of oral and maxillofacial Control study. Indian journal of Applied Research. 2016; support the result of our study. We found that 35% the chances of neurological injury. Fracture of the injuries in Nigeria: a review of the literature. Head Face 6(3): 528-531. Med. 2005; 1:7. patient had cerebral contusion. But at the same time, mid-face was found to be most commonly associated 22.Malara P, Malara B et al:characteristics of maxillofacial as in present series, all patients who sustain moder- with head injury and the management of both neuro- 8. Van Hoof RF, Merkx CA, Stekelenburg SC. The different trauma resulting from road traffic accidents- a 5years ate or severe head injury also, had associated intrac- logical and maxillofacial injury was done according to patterns of fractures of the facial skeleton in four European review. Head and Face medicine. 2006:2:27. ranial injuries reflecting the severity and complexity of the necessity. countries. Int J Oral Surg.1977; 6 (1): 3-11. craniofacial trauma.18 23.Obuekwe ON, Ojo MA, Akpata O. Maxillofacial trauma Apart from maxillofacial fractures, high velocity Recommendations: 9. Brown RD. Cowpe JG. Patterns of maxillofacial trauma in due to road traffic accidents in Benin City, Nigeria: A impacts may result in ruptures of intracranial vessels, In view of the high association of closed head injury in two different cultures: Acomparison:between Riyad and prospective study. Annals of African Medicine. 2003; 2(2): leading to life-threatening intracranial hemorrhage, the facial fracture population, as well as high potenti- Tayside. JR Coil surg Edinb.1985; 30(5): 299-302. 58-63. Intracranial hemorrhage was found in 45% cases in ality for mortality and neurological morbidity the present study, which was more as compared to previ- 10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture 24. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A authors of present study recommend the routine use patterns: A suburban trauma center experience. An J review of 100 closed head injuriesassociated with facial ous studies28.This may be due to the difference in the of head CT for all patients sustaining a facial trauma Otolaryngol. 2004; 25 (5): 301-307. fractures. J Oral Maxillofac Surg. 1992;50:218-22. mode and severity of injuries. and close monitoring of neurological status of these About intracranial lesions most of the victims had patients. 11. Ansari MH. Maxillofacial fractures in Hamedan provi- 25. Chowdhury D. Depressed skull fractures: analysis of subdural haemorrhage 18.3%, followed by extradural ence, Iran: A retrospective study (1987-2001). J Cranio- clinical outcome and cost effectiveness of timely surgical haemorrhage (15%), and subarachnoid haemor- Consent for the study maxilloac Surg.2004; 32 (I): 28-32. management. MS (Neurosurgery) thesis, BSMMU, 2002. rhage (11.7%). In a study from India by Ashok KG et • All patients or relatives were given a necessary 12. Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. 26. Gwynn P, Carraway JH, Horton CE, et al: Facial al, showed that 5% victims had subdural haemor- explanation about the study before they asked to Characteristics of associated trauma in patients with head fractures-associated injuries and complications. Plast and rhage 14% had subarachnoid haemorrhage and 13% participate. had extradural haemorrhage14 which is identical to injuries: An experience with 100 cases. J Trauma and Reconstr Surg. 1971; 47: 225-230. • For those patients who were unconscious, consents Shock. 2009; 2(2): 89-94. our study. were obtained from their relatives. 27. Pappachan B,Alexander M. Correlating facial fractures The results of previous studied evaluating the • For patients under ages 18 years, informed 13. Adekeye SO. The pattern of fracture of facial skeleton in and Cranial Injuries. J Oral Maxillofacial Surg. 2006; relationship between facial and head injuries are consents were obtained from their parents/ guardi- Kaduna Nigeria. A survey of 1447 cases. Oral Surg. 1980; 64:1023-1029. conflicting. Hohlrieder et al reported that Le Fort- ll ans. 49(6): 491- 495. and lll, Orbit, Nose,, Zygoma and Maxillary fractures 14. Ashok KG, Ran’ineesh G, Asish C. A retrospective 28. Zandi M, HoseiniSR. The relationship between head were associated with a 2-to 4 fold risk of intracranial analysis of 189 patients of maxillofacial injuries presenting injury and facial trauma: a case- control study. J oral and References: to a tertiary care hospital in Punjab, India. J Maxillofac Oral maxillofacial surgery. 2013; 7(3):201-207. hemorrhage, while mandibular fracture did not signifi- 1. Sharmin FN, Cameron P et al. Maxillofacial trauma in Burg. 2009; Sep;8(3):241-5. cantly increases the chance of intracranial hemor- major trauma patients. Aus Den Journ. 2006; rhage21. Haug et al. reported that although the mandi- 51(3):225-230. 15. Haug RH, Foss J. Maxillofacial injuries in the pediatric ble was the most frequent fractured bone in patients patient. Oral Surg Oral Med Oral Pathol of Oral Radio 2. Follmar KE, Debruijn M, Baccarant A, Bruno AD, Muku- with concomitant facial and head injuries, midface Endod. 2000; 90:126-134. fractures were more frequently associated with ndan S, Erdmann D et al Concomitantinjuries in patients relationship with the help of interocclusal recording ring that fits around the borders acts as a mold for the metallic die and were copied in the samples during Table-I: Distribution of horizontal distance in group A materials. These materials should have good dimen- impression material. The thickness of ring was 0.3 cm their fabrication. sional stability to achieve proper articulation4. Many and the diameter of the ring was 3cm. Therefore the The distance between the two reference points of materials are available for interocclusal record. These stainless steel die include stainless steel ring and each sample (A1_C1, and A2_C2) were measured by include: Bite registration wax (Aluwax, HiFi, base- stainless steel test block. The distance between the a traveling micrometer microscope. It had a millimeter plate), zinc-oxide eugenol paste, Addition silicone two parallel reference lines A and C was measured at scale and a vernier scale which were attached (polyvinylsiloxane), Polyether elastomer, Impression two fixed points. These reference points were scribed together and with the help of vernier scale it was compound, Impression plaster of paris, Acrylic resin, in the metallic die and were copied in the sample possible to measure up to 10 micrometer i.e. 0.01 Thermoplastic resin, Alginate (irreversible hydrocol- during their fabrication. millimeter. The two reference points between the loid), Condensation type silicone, Eugenol free zinc For polyvinylsiloxane specimen: vertical parallel line were measured through a magni- oxide eugenol paste4,5,6. Intercclusal recording mate- Two equal length of base and catalyst according to fying tube attached with the traveling micrometer rials are basically similar to impression materials but the manufacturers recommendation and kneaded microscope. At first reference point A1 was placed GroupA: polyvinylsiloxane; n:Total number of sample are modified to give good handing characteristics4. with clean finger instead of wearing latex gloves to beneath the magnifying tube on the platform of the Table-I shows that mean±SD was 6.00±0.00 after Each of these has advantages and disadvantages as prevent sulfur contamination from these gloves which microscope. The measurement M1 was recorded by one hour follow up visit 5.97±0.38 after 24 hours, interocclusal recording materials. In Bangladesh inhibits the setting of the addition silicone interocclu- the following formula. M1= (Reading of millimeter 5.92±0.04 after 48 hours and 5.82±0.04 after 72 most popular interocclusal recording materials are sal recoding material and may produced major distor- scale + Reading of vernier scale x vernier constant i.e hours follow up visit. It was indicated that maximum alginate5. Alginate has limitation but it also has some tion. Then kneaded material together (approximately 0.01) mm. Then the platform was horizontally moved horizontal distance between A & C after one hour advantages too over the other materials that make it 45 seconds) until a uniform, streak free color was without shifting the sample and with the help of rotat- follow up visit and minimum horizontal distance more valuable. Because of its extreme fluidity before achieved. It was then placed on the surface of the die ing the platform screw. Now reference point C1 was between A & C after 72 hours follow up visits. setting and its resilency after setting, alginate causes for impression making. fixed under the magnifying tube. The measurement Table II: Distribution horizontal distance in different minimal tooth and tissue displacement when occlusal For alginate specimen: M2 was measured by the same formula. Measure- follow up of group B registrations are made with it5. Posselt thought that For mixing alginate powder and water were meas- ment of the distance between A & C parallel lines at alginate records were superior to wax, but shrinkage ured according to the manufacturer’s recommenda- reference point between A1C1 is done by subtracting made them useless after a few minutes7. The dimen- tion at room temperature. The measured powder M1 from M2. So A1C1=M2-M1. In the same way, sional stability of interocclusal recording materials (9gm) was shifted into premeasured water (17ml) that horizontal distance between A2_C2 was measured. over time is of utmost importance, as it ensures a had already been poured into a clean rubber bowl. The mean of two readings were used for calculation more accurate representation of the patient's maxillo- The powder was incorporated into the water by care- for each sample. Reading was recorded for all 10 mandibular relationship10. So the study was done to fully mixing. Mixing time (30 seconds) was carefully samples of each group at intervals of 1 h, 24h, 48h & compare the dimensional stability of polyvinylsilox- maintained and after that it was placed on the surface 72 hours. The measurement data was collected from ane and alginate at various times of intervals (1h, 24 of the die for impression making. samples of each group and was recorded in data hs, 48 hs, 72 hs). Sample collection: collection sheet. Horizontal linear distance between Group B : Alginate; n:Total number of sample After homogenous mixing, the materials were carried A1 C1 and A2 C2 is measured in millimeters. Table-II shows that mean±SD was 5.68±0.05 after Materials & Methods to the die. The stainless steel die was inverted on to a Statistical analysis: one hour follow up visit, 5.56±0.02 after 24 hours, Introduction lation. In these situations, the patients’ interocclusal This comparative in vitro study was carried out 4x4 inch square glass plate covered with polyethyl- Data analysis was done by using computer based 5.49±0.03 after 48 hours and 5.41±0.06 after 72 Inter occlusal records are the means whereby inter records are made and sent along with the cast to the Department of Prosthodontics, BSMMU, Dhaka, from ene sheet. Hand pressure was applied for about five program SPSS (Statistical Package for Social hours follow up visit. It was indicated that maximum arch relationship are transferred from mouth to an laboratory. This requires that the records must be June 2009 to 2010. Duplicated disk of polyvinylsilox- seconds initially to express the materials followed by Sciences) version 12. Paired t test was done to find horizontal distance after one hour follow up visits and articulator1. Maxillomandibular records are necessary dimensionally stable for the given period of time ane and alginate obtained from custom made stain- application of a 500 g weight to further remove of out statistical significance value. The results were minimum after 72 hours follow up visits. 2 to study the status of the dentition and to construct before they are used to articulate the casts . Record- less steel die were used as a sample. The sample excess materials. Each assembly remains for the presented in tables and figures. The result of signifi- Table III: Comparison of horizontal distance in group dental restoration. One type of record is used for ing maxillomandibular relationship is an important size of the study was twenty. Only freshly prepared manufacturer suggested setting time ie alginate for 2 cance was expressed as p value. P value <0.05 was A and group B mounting casts of the teeth or setting the articulator step in oral rehabilitation. This relationship is trans- duplicated disks from die were selected. minutes 20 seconds and additional three minutes to considered as significant. adjustments and another for appraising the degree of ferred to the articulator so laboratory procedure done Group of sample: ensure polymerization of materials. The mold assem- occlusal or incisal tooth contacts2. Adequate laborato- on the cast will be corresponding with patients’ Group A: 10 disks were made with polyvinylsiloxane. bly was removed from the stainless steel die and all Results 3 ry facilities are commonly not available locally and mouth . To create a harmonious occlusion, it is Group B: 10 disks were made with alginate. excess materials were trimmed. Samples were stored The present in vitro study was intended to compare casts have to be sent to others laboratories for articu- essential to record the existing maxillomandibular Preparations of stainless steel die: in room temperature. Later specimens were prepared the dimensional stability of polyvinylsiloxane and The stainless steel die had two portions: a round in the form of a disk measuring 3cm in diameter with alginate at various times of intervals. Total 20 sam- stainless steel test block and a stainless steel ring4 three parallel lines on the surface. ples were evaluated. The findings of the study that fits around the borders and acts as a mold for the Measurement of the test samples: obtained were analyzed and presented below. specimen. A round stainless steel die was construct- These three lines were named A, B & C which were ed for testing dimensional change. Three parallel equally separated by a distance of 3 mm. The lines were included on the die surface. These three distance between the two parallel reference lines, A & C, were measured at two fixed points (A1C1 and Group A polyvinylsiloxane, Group B Alginate, The mean lines were named A, B and C which were equally difference is considered significant if p< 0.05. * Significant separated by a distance 3 mm. The stainless steel A2C2). These reference points were scribed in the

Update Dental College Journal Vol. 7 No. 1 | April 2017

Table-III shows that after 1 hour follow up visit Conclusion (RTC) were the most frequent cause of facial energy trauma causing maxillofacial injury are high the Oral and Maxillofacial surgery Department. Figure 1: Sex distribution of the patients (n=60) Table 3: Distribution of fracture facial bones (n=60) Table-5: Cross tabulation between pattern of facial 8.09:112. This indicates that males are more prone to beaten by her male partner and/or family members 7,8 1,2,3,4 mean±SD was 6.00±0.00 in group A and mean±SD In this study we concluded that dimensional stability injuries However more recent studies have shown enough to cause concomitant head injury . The Number fracture and severity of head injury (n-60) maxillofacial injury with or without head injury this for dowry for other reasons. We found only 1.7% in of patients Percent GCS stage was 5.68±0.05 in group B. After 24 hours follow up is influenced by both Material and time factors. It that assault is now the most common cause of maxil- purpose of this study was to evaluate the pattern of Statistical analysis Facial bone fracture P value high vulnerability of male gender for all type of trauma our study. visit mean±SD was 5.97±0.08 in group A and decreased as the time factor is increased. Polyvinyl- lofacial injuries in developed countries9,10 where as head injuries in Patients with maxillofacial trauma and Mandible Fracture (total- 22) 36.67 Very mild Mild Moderate Severe can be attributed to the fact that in our society males Isolated mandible fractures are most common facial After the patient had given consent to be included in Parasymphysis fracture 1 1 0 0 mean±SD was 5.56±0.02 in group B. After 48 hours siloxane were dimensionally more stable than traffic accidents remain the most frequent cause in to co relate the relationship between them. the study, a standardized structured data collection Symphysis fracture 4 6.7 Parasymphysis+condyle 2 2 2 0 are predominantly the bread bearing for the family. bone to be fractured ranging from 12.9% to as high as 11 follow up visit mean±SD was 5.92±0.04 in group A alginate interocclusal material. many developing countries like Bangladesh. Others sheet was used to collect necessary information of Parasymphysis fracture 2 3.3 Symphysis fracture 1 1 2 0 Moreover they are at higher risk of injuries than 72.9%, followed by midface ranging from 25.9% to and mean±SD was 5.49±0.03 in group B. After 72 causes of maxillofacial trauma are fall from height, the study subject. The data were screened and Parasymphysis+condyle 6 10.0 Angle of mandible 0 2 5 0 women because of their greater exposure of automo- 29.5%11,12,21 the other frequently affected bones are Material and methods: Condyle fracture Angle of mandible 7 11.6 0 0 2 0 hours follow up visit mean±SD was 5.82±0.04 in References assaults, altercation, pedestrian injury, home and This was a descriptive type of cross-sectional study checked for any missing value and discrepancy. The (isolated) bile and motorcycle accident and engaged in more the floor of the orbit and nasal bones. However, in the group A and mean±SD was 5.41±0.06 in group B. industrial accidents and athletic injuries, in descend- carried out at the department of Oral & Maxillofacial data were then processed and analyzed using statis- Body of mandible 1 1.7 Body of mandible 1 0 0 0 0.002S risky behavior like hanging on the side of the bus or present series, the most frequent maxillofacial injury 12 Condyle fracture (isolated) 2 3.3 Zygomatico-maxillary The difference was statistically significant (P<0.05) 1. Skurnik H. Resin registration for interocclusal recods. J ing order of frequency . Surgery, Bangabondhu Sheikh Mujib Medical Univer- tical software SPSS (statistical Package for Social 0 1 8 2 rush to get in a running bus. represented was the fractured mandible 36.6%, Zygomatico-maxillary fracture including orbit 11 18.3 fracture including orbit between group A and group B in different follow up ProsthetDent.1977;21(2):164-170. The peak age of incidence of maxillofacial injuries sity, Shahbag, Dhaka. The period of study was from Science) version16. Chi- square test was carried out Lefort-I 0 2 4 0 In our study, it was found that majority of patients followed by fractured Zygomatico-maxillary complex 13 Lefort-I 6 10.0 Lefort-II 0 0 8 3 visits. among 21 -30 years and more males are involved in 1st May 2010 to 30th April 2011. The patient’s data and significant level p value of < 0.05 was considered Lefort-II 11 18.3 were in the age group between 2nd to 4th decade including orbit and Lefort fractures. In a survey by 2. Dua MP, Gupta SH, Ramachandran S, Sandhu HS. 14 Lefort-III 0 0 0 7 maxillofacial injuries than females . Children are were collected from Inpatient department of Neuro- statistically significant. The summarized data were Lefort-III 7 11.7 and mean age was 29.63 years which is similar to Malara P et ai in 2006, they found in 198 patients that Evaluation for four elastomeric interocclusal recoding mate- Fig-1: Shows that among patients with both maxillofacial Nasal bone fracture 1 0 2 0 21 Discussion uniquely susceptible to maxillofacial injury because of surgery, Dhaka Medical College &Hospital and inpa- present in the form of tables, graphs and bar Nasal bone fracture 3 5.0 Total 6 9 33 12 60 other studies of the globe. The possible explanation 18.69%suffered mandibular fracture, 12.63% Zygo- rials. MJAFIl. 2007 ;63 (3) : 237-240. 15 and head injury 88.3% were male and 11.7% were female. The linear dimensional changes of two interocclusal their disproportionate cranial-body mass ratio . tient department of Oral and Maxillofacial Surgery, diagrams by the help of statistician. Total 60 100.0 S = Significant for this is that the people in this age group take part in matic complex fracture and 12.2% maxillary Patients older than 65 years account for approxi- dangerous exercise and sports, drive motor vehicles fractures22. Obuekwe and Etetafia in 2004 found in recording materials were measured over time in this 3. Tripodakis AP, Vergos VK, Tsoutsos AG. Evaluation of Bangabondhu Sheikh Mujib Medical University, Table 2: Distribution of mode of injury (n=60) Table-3: Shows mandible was the most commonly Table-5: indicates that most of the zygomatic- maxillary study. These measurements provided an indication of the accuracy of interocclusal records in relation to two mately 1% of maxillofacial trauma, and falls on a Shahbag, Dhaka who were referred from other Results and Observation: fractured facial bone (36.67%) (n=22) at different anatomi- complex fracture including orbit occurred in case of moder- carelessly and are more likely to be involved in their study, that mandible was the most common site the dimensional stability of those materials. However, recording techniques. J Prosthet Dent.1997; 77 (2): slippery ground is the most common cause in this age Neurosurgical center. The total of 60 patients who cal locations. Both Zygomatico-maxillary complex fracture ate head injury and most of the Lefort-II fracture occurred in violence. Patients less than 10 years and more than of fracture, followed by Zygomatic complex and max- 16 23 dimensional stability can also be studied in all the 141-146. group . sustained both cranial and facial injuries were includ- Table-1: Age distribution of the study subjects (n=60) and Lefort-II fracture were equal frequency 18.3% (n=11). patients with moderate and severe head injury. And most of 60 years were less frequently affected in our series. illa . The results of our study therefore correlate with three planes using equipments like the condymeter, It was evident that the facial bones fractures were ed in this study. After taking informed consent, data the Lefort-III fracture occurred in patient with severe head These could be explained that children are usually other literatures. computerized Axitron and Buhnergraph4. Table 1 4. Karithikeyan K, Annapumi. Comparative evaluation of uncommonly singular with compound and comminut- were collected by history, through clinical examina- Table-4: Distribution of involvement of cranium (n=60) injury. taken care of by elders during travelling and lesser In this study we found among LeFort fractures Number of shows group A exhibited no significant difference dimensional stability of three types of interocclusal record- ed nature adding on to the complexity of facial tion, radiographic evaluation and Neurosurgical Involvement of cranium Percent mobility of geriatric people. But the effect of head LeFort- ll is more common (18.3%), than LeFort lll patients Graph 3: Correlation between pattern of facial fracture between the die scribe and those of the sample at the ing materials: an in vitro study. Journal of Indian Prostho- fractures. It is a common concept of fracture nasal consultation. Appropriate skull X-Rays were done in injury is disproportionately severe in elderly and they (11.7%) and LeFort – l. The pattern is identical to Scalp injury 14 23.3 and severity of head injury 2 dontic Society.2007; 7(1) :24-27. 15 immediate reading. Nisan et al observed that addi- bone being the most common facial bone to be all patients and patients with impaired conscious- Linear fracture 19 31.6 require more neurosurgical care. studies conducted by Haug HR, Foss J. in 2000 . fractured, then the zygoma followed by mandible and 9 The main causes of craniofacial injury worldwide are Our results demonstrated lower incidence of Nasal tion type silicone, polyvinyl siloxane is most accurate ness, neurological sign or clinical sign of basal skull Depressed fracture frontal bone 10 16.6 8 5. Scott WR .Occlusal registration using alginate (irreversi- 17 and stable interocclusal recording material. Table II ble hydrocolloid) impression material.J Prosthet Dent. maxilla. fracture, an initial CT scan was also performed. Depressed fracture temporal 3 5.0 8 assaults and road traffic accidents, but the preva- bone fracture (5%), although it is a common concept Apart from maxillofacial injury, high velocity impacts Depressed fracture parietal 2 3.33 7 lence varies depending on the demographics and of fracture Nasal bone is the most frequent facial shows in group B the same result. Table III shows 1978;40(5) :51 7-519. Information regarding age, gender, cause of injury, Zygomatico-maxillary 6 comparison of horizontal distance between group A may result in fracture of facial bones and life threaten- pattern of facial and/or head injuries, loss of Depressed fracture occipital 1 1.67 fracture including orbit geography of the area. Road traffic accidents (RTA) bone to be fractured. It probably comes from the fact Basal Skull Fracture 0 0 5 (n=11) and group B. The difference was statistically signifi- 6. Lassila V. Comparison of five interocclusal recording ing intracranial hemorrhages in different compart- consciousness, and GCS score were obtained and Table 2: indicates that majority of the victims suffered by are the commonest cause of craniofacial trauma in that isolated Nose fracture was managed by other CSF Leakage 4 Lefort-III (n=7) material. J Prosthet Dent.1986 ; 5: 215-218. ments requiring urgent neurosurgical intervention19. A motor vehicle accidents (60%), (n=36) followed by fall from most of the series5,11,12,20 and this occurred largely in specialties like ENT and Plastic Surgery. cant (p<0.05) of all follow up visit between group A recorded in questionnaires. 11.66 3 8 height (13.3%) (n=8) and pedestrians (11.7%), (n=7). Rhinorrhoea 7 2 and group B. Above reports showed similar results . decrease in the level of consciousness is the single The causes of injury were summarized as follows: 2 our circumstance also (60%) because of reckless- GCS is a good marker for determining potential brain 6.66 1 9 7. Eriksson A, Eriksson GO, Lockowandt P, et al .Materials Some researchers carried out an experimental study most reliable indicator that the patient has a serious Motor vehicle accidents, Fall from height, Pedestrian, Otorrhoea 4 1 ness and negligence of the drivers, poor mainte- injury, clinical conditions and prognosis of the patients for reliable interocclusal measurements. Br Dent J.2002 20 Mean ± SD = 29.63±12.0 Range = (5 - 64 years) Graph 2: Distribution of Glasgow Coma Score (GCS) Total 60 100.0 24 and found that addition silicone presented smaller head injury or secondary insult to the brain . Loss of Assault, Sports injuries, Work-related injuries, and of the patients (n=60) 0 nance of vehicles, often driving under the influence of following trauma . On the basis of GCS scores of the ;192 (7) : 385-400. intracranial hemorrhages, closed head traumas Majority of the victims were in the age group of 21 to Mild Moderate Severe linear when compared to alginate. Moisture, especial- Introduction: consciousness is the manifestation of intracranial others. Table- 4: indicate that Linear fracture were more (31.6%) alcohol or drugs and complete disregard of traffic patients, It was found that, majority of patients with Maxillofacial trauma and concomitant head injuries (brain contusion or laceration), or fractures. General- 40 years (75%), with 21-30 years (51.7%) more ly, can cause considerable dimensional changes in 8. Lassila V, McCabe JF. Properties of interocclusal regis- injury or concussion head injury (62%), followed by Facial injuries included facial bone fractures and/or (n=19) then depressed fracture (n=16) and scalp injury. laws. Fall from height was the second most common head injury according to their GCS score were classi- carry the significant potential for mortality and neuro- ly, the presence of emesis, vomiting, loss of affected among this group. Children less than 10 yrs alginate. Therefore great care is taken wrapping and tration materials.J Prosthet Dent. 1985; 53: 100-104. headache (33%), vomiting (27%), nasal bleed (30%) soft tissue injuries. Facial bone fractures were classi- Discussion: cause of injury in our series and attributed to 13.3%, fied as having moderate head injury 55% (n=33), consciousness, or a low Glasgow Coma Scale (GCS) 21 and elderly >60yrs of age made up a less frequency. packaging them during storage and transfer. Few logical morbidity. Maxillofacial trauma can occur as and oral bleed (10%) . fied as mandibular, Lefort I, Lefort II, Lefort III, Zygo- Figure-2: Distribution of type of head injury (n=60) Bangladesh is a south Asian developing country this occurred mostly in urban area where lot of followed by severe head injury 20% (n=12),mild head an isolated injury or in combination with other severe score are important findings for suspicion of a cranial authors have suggested ideal times for articulation of 9. John J, Manapallil. Basic Dental Materials. 2nd ed .New The Glasgow Coma Scale score(GCS) is used to matico-maxillary fracture including orbit, and Nasal Type of head injury where poverty and unemployment forcing the people peoples worked as a day labour in construction of injury 15% (n=9), and minor head injury 10% (n=6) 1 injury. However, in patients with maxillofacial trauma, Graph 1: Age Distribution of the study subject (n=60) casts with respect to the type of interocclusal records Delhi: Jaypee Brothers medical publishers (p). Ltd.2003 : injuries . Patients with maxillofacial trauma may pres- quantify neurologic findings and it is widely accepted bone fractures. The types of mandibular fractures towards urban areas. This rapid and unplanned high rise buildings and painting them. It is in accord- respectively. The results from this study showed a used. The result of this present study was consistent 58. ent with associated intracranial, pulmonary, intra-ab- head trauma may also be seen without observing the and a standardized method for evaluating level of were classified by anatomic site (condyle, ramus, ance with others findings from South India, which significantly higher incidence of moderate type of 2,3 6 Concussion urbanization associated with incompetent traffic suggestive findings . 11.7 20 with the above study. Thus, it becomes mandatory to dominal or extremity injuries . A close relationship consciousness depending on the score of the GCS angle, body, symphysis, parasymphyses and coro- system, unplanned roads and highways, violation of reported 16,6% of Craniofacial trauma were due to head injuries associated with maxillofacial injuries as 10. Michalakis KX, Argiris P, Vassiliki A. Experimental The etiology of maxillofacial injuries varies from one 15 12 choose a material depending not only on the clinical between maxillofacial fracture and intracranial injury head injury can be classified as very mild, mild, mod- noid). Contussion traffic laws by the drivers and pedestrian injury, over- fall from coconut tree. In our study, we found, compared to other reports in the English literature. study on Particular Physical Properties of several Interoc- 4-6 country to another and even within the same depend- situation but also on the time taken for the articula- has been reported in many articles . In many coun- erate and severe head injury. About intracranial Head injuries included skull fractures and/or intracra- crowding, etc are responsible for highest figure of pedestrians constituted 11.7% of the total victims. In In case of head injury, various pattern of skull fracture clusal Recording Media. Part II: Linear Dimensional tries, cranial injury has been found to be the most ing on the prevailing socioeconomic, cultural and Subdural haemorrhage tion. From above study I found that dimensional Change and Accompanying Weight Change. Journal of lesions, contusion/ concussion, extradural hemato- nial injuries. Skull fractures were classified into scalp road traffic accidents, and these RTA victims are Dhaka city, a large number of pedestrians are were found. Linear fracture was the commonest type common accompanying organ injury in patients with environmental factors. Earlier studies from Europe changes of polyvinylsiloxane inter occlusal recording ma, subdural hematoma, subarachnoid hematoma injury, linear fracture and depressed fracture of 18.3 Extradural haemorrhage garments employees and day labor. They have lack (31.6%) followed by depressed fracture (26.6%). Prosthodontics. 2004 ;13(3) :150-159. 3,4 35 mainly suffered from Craniofacial injury. material was not significant in a horizontal plane after maxillofacial trauma . These includes head traumas, and America revealed that Road Traffic crashes and intracerebral haematoma occurs most frequent- frontal, temporal, parietal, occipital, and basal skull Above figure indicates that most of the study population of knowledge regarding traffic rules, shortage of Linear fracture was the commonest one because Subanachnoid In the present study, majority of the head and 20 suffered from moderate head injury (55%), (n=33), followed 1 and 24 hours. The changes after 48 and 72 hours ly . fractures. Intracranial injuries were summarized as haemorrhage concomitant facial injuries were experienced by space in footpath, most of which are occupied by the during RTA head strikes by forcible contact with broad were lesser than other group. So it can be concluded Existing literature on the correlation of traumatic head concussion, cerebral contusion, and intracranial by severe head injury (20%) (n=12), mild head injury (15%), hawkers. Most of the pedestrians are not used to use resting surface like roads18. This result was identical (n=9) and very mild head injury (10%) (n=6). males, constituted 88.3% and females constituted that polyvinylsiloxane is more dimensionally stable injuries and maxillofacial trauma Is highly controver- hemorrhage (epidural, subdural, intracerebral and the pedestrian’s bridge. That’s why pedertrain injury to other study done by Ahmed et al in 2009 in Bang- Above figure indicates that, most of the study population only 11.7% of the total victims. The male to female sial. Some suggest that it is the facial skeleton that is a common cause of injury in our country. Domestic ladesh.20 Regarding depressed fracture of individual interocclusal recording materials than alginate. subarachnoid). Above graph indicates that 21-30 years age group was suffered from contussion (35%) (n=21). 18.3% had ratio was 7.57:1. These results are similar in a study absorbs the energy of the trauma, protecting the Brain trauma was handled by Neurosurgery depart- more commonly affected. subdural hemorrhage (n=11) and 15% had Extradural from India, where 89% of subjects were males and violence is another cause of craniofacial trauma in bones, Frontal was most prone to fracture (16.66%) brain from injury, whereas, others suggest that high ment and complex facial fractures were repaired by haemorrhage (n=9). 11% were females, giving a male to female ratio our country, where the women are most of the time followed by fracture temporal bone (5%) and parietal

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bone. This coincides with other study done previously closed head injuries than mandible fracture.19 These with panfacial fractures. J Trauma. 2007; 63:831-5. 16. Rehman K, Edmcndson H. The causes and conse- at BSMMU in Bangladesh in 2002.25 difference in the facial bone or head injury being stud- quences of maxillofacial injuries in elderly people. Gero- In agreement with a study by Pappachan and Alexan- ied and the variation in classification, nomenclature 3. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associ- dontology. 2002; 19:60-64. der, we observed that CSF rhinorrhoea was nearly or methodology of prior studies may explain these ated injuries in facial fractures: review of839 patients. Br J Plast Surg. 1993;46:635-8. 17. Khan AR, Arif S. Ear nose and throat injuries in children. twice as frequent as CSF otorrhoea.27 This may be conflicting result. In the present study we demonstrat- J Ayub Med Coll Abbottabad.2005; 17:54-6. explained by the fact that anterior Cranial base is ed that LeFort- lll fracture was the strongest predic- 4. Mulligan RP, Friedman JA, Mababir BC. A nationwide relatively closer to midfacial structures and has more tor of severe head injury, followed by LeFort- ll and review of the associations among cervical spine injuries, 18. Davidoff G, Jakubowski M, et al. The spectrum of sutural connection with midfacial bones compared to Zygomatico-maxillary fracture including Orbit this head injuries, and facial fractures. J Trauma. closed- head injuries in facial trauma victims:incidence and the middle cranial base. Thus, the chance of anterior coincide with the other findings done by Kloss et al. 2010;68:587-92. impact. Ann Emerg Med.1998; 17:6-9. cranial base fracture and resulting CSF rhinorrhoea is reported that LeFort- lll fracture was the strongest expected to be higher. predictor of intracranial bleeding. 5. Gwyn PP, Carraway JH, Horton CE, Adamson JE, 19. Egol R, Fromm KR, et al. Guideline for intensive care Similar to other studies the most common neurologi- Mladick BA. Facial fractures-associated injuries and unit admission, discharge, and triage. Cr/f Care Med 1992; complications. Plast Reconstr Surg. 1971;47:225-30. 27:633-638. cal symptom was loss of consciousness, which can Conclusion be manifestation of intracranial injury or concussion Adult males in the age group of 20-40 years were the 18,24 6. Kloss F, Laimer K, Hohlrieder M, Ulmer H, Hacki W, 20. Ahmad M, Rahman FN, Chowdhury MH, et al. Postmor- head injury which was also more common in most common victims of craniofacial trauma. Road Benzer A, et al. Traumatic intracranial haemorrhage in tem study of head injury in fatal road: traffic accidents. 21,24 patients with fracture of the upper face moreover traffic accidents were responsible for the majority and conscious patients with facial fractures-a review of 1959 JAFMC.2009; 5 :(2):24-28. loss of consciousness is less common with isolated most of the patients sustained moderate head injuries cases. Craniomaxillofac Surg. 2008;36:372-7. facial fractures. Gwynn et al found that life threaten- that were then managed conservatively. Fracture 21. Pradeep G, Ankit J, Nirmal K G. Association of Head ing injuries such as cerebral concussion were mandible was the most common maxillofacial injury 7. Adeyemo WL, Ladeinde AL, Ogunlewe MO, James injury and Maxillofacial Trauma: A prospective Case- frequently associated with facial fractures26 which .More severe were the maxillofacial injury more were O.Trends and characteristics of oral and maxillofacial Control study. Indian journal of Applied Research. 2016; support the result of our study. We found that 35% the chances of neurological injury. Fracture of the injuries in Nigeria: a review of the literature. Head Face 6(3): 528-531. Med. 2005; 1:7. patient had cerebral contusion. But at the same time, mid-face was found to be most commonly associated 22.Malara P, Malara B et al:characteristics of maxillofacial as in present series, all patients who sustain moder- with head injury and the management of both neuro- 8. Van Hoof RF, Merkx CA, Stekelenburg SC. The different trauma resulting from road traffic accidents- a 5years ate or severe head injury also, had associated intrac- logical and maxillofacial injury was done according to patterns of fractures of the facial skeleton in four European review. Head and Face medicine. 2006:2:27. ranial injuries reflecting the severity and complexity of the necessity. countries. Int J Oral Surg.1977; 6 (1): 3-11. craniofacial trauma.18 23.Obuekwe ON, Ojo MA, Akpata O. Maxillofacial trauma Apart from maxillofacial fractures, high velocity Recommendations: 9. Brown RD. Cowpe JG. Patterns of maxillofacial trauma in due to road traffic accidents in Benin City, Nigeria: A impacts may result in ruptures of intracranial vessels, In view of the high association of closed head injury in two different cultures: Acomparison:between Riyad and prospective study. Annals of African Medicine. 2003; 2(2): leading to life-threatening intracranial hemorrhage, the facial fracture population, as well as high potenti- Tayside. JR Coil surg Edinb.1985; 30(5): 299-302. 58-63. Intracranial hemorrhage was found in 45% cases in ality for mortality and neurological morbidity the present study, which was more as compared to previ- 10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture 24. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A authors of present study recommend the routine use patterns: A suburban trauma center experience. An J review of 100 closed head injuriesassociated with facial ous studies28.This may be due to the difference in the of head CT for all patients sustaining a facial trauma Otolaryngol. 2004; 25 (5): 301-307. fractures. J Oral Maxillofac Surg. 1992;50:218-22. mode and severity of injuries. and close monitoring of neurological status of these About intracranial lesions most of the victims had patients. 11. Ansari MH. Maxillofacial fractures in Hamedan provi- 25. Chowdhury D. Depressed skull fractures: analysis of subdural haemorrhage 18.3%, followed by extradural ence, Iran: A retrospective study (1987-2001). J Cranio- clinical outcome and cost effectiveness of timely surgical haemorrhage (15%), and subarachnoid haemor- Consent for the study maxilloac Surg.2004; 32 (I): 28-32. management. MS (Neurosurgery) thesis, BSMMU, 2002. rhage (11.7%). In a study from India by Ashok KG et • All patients or relatives were given a necessary 12. Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. 26. Gwynn P, Carraway JH, Horton CE, et al: Facial al, showed that 5% victims had subdural haemor- explanation about the study before they asked to Characteristics of associated trauma in patients with head fractures-associated injuries and complications. Plast and rhage 14% had subarachnoid haemorrhage and 13% participate. had extradural haemorrhage14 which is identical to injuries: An experience with 100 cases. J Trauma and Reconstr Surg. 1971; 47: 225-230. • For those patients who were unconscious, consents Shock. 2009; 2(2): 89-94. our study. were obtained from their relatives. 27. Pappachan B,Alexander M. Correlating facial fractures The results of previous studied evaluating the • For patients under ages 18 years, informed 13. Adekeye SO. The pattern of fracture of facial skeleton in and Cranial Injuries. J Oral Maxillofacial Surg. 2006; relationship between facial and head injuries are consents were obtained from their parents/ guardi- Kaduna Nigeria. A survey of 1447 cases. Oral Surg. 1980; 64:1023-1029. conflicting. Hohlrieder et al reported that Le Fort- ll ans. 49(6): 491- 495. and lll, Orbit, Nose,, Zygoma and Maxillary fractures 14. Ashok KG, Ran’ineesh G, Asish C. A retrospective 28. Zandi M, HoseiniSR. The relationship between head were associated with a 2-to 4 fold risk of intracranial analysis of 189 patients of maxillofacial injuries presenting injury and facial trauma: a case- control study. J oral and References: to a tertiary care hospital in Punjab, India. J Maxillofac Oral maxillofacial surgery. 2013; 7(3):201-207. hemorrhage, while mandibular fracture did not signifi- 1. Sharmin FN, Cameron P et al. Maxillofacial trauma in Burg. 2009; Sep;8(3):241-5. cantly increases the chance of intracranial hemor- major trauma patients. Aus Den Journ. 2006; rhage21. Haug et al. reported that although the mandi- 51(3):225-230. 15. Haug RH, Foss J. Maxillofacial injuries in the pediatric ble was the most frequent fractured bone in patients patient. Oral Surg Oral Med Oral Pathol of Oral Radio 2. Follmar KE, Debruijn M, Baccarant A, Bruno AD, Muku- with concomitant facial and head injuries, midface Endod. 2000; 90:126-134. fractures were more frequently associated with ndan S, Erdmann D et al Concomitantinjuries in patients relationship with the help of interocclusal recording ring that fits around the borders acts as a mold for the metallic die and were copied in the samples during Table-I: Distribution of horizontal distance in group A materials. These materials should have good dimen- impression material. The thickness of ring was 0.3 cm their fabrication. sional stability to achieve proper articulation4. Many and the diameter of the ring was 3cm. Therefore the The distance between the two reference points of materials are available for interocclusal record. These stainless steel die include stainless steel ring and each sample (A1_C1, and A2_C2) were measured by include: Bite registration wax (Aluwax, HiFi, base- stainless steel test block. The distance between the a traveling micrometer microscope. It had a millimeter plate), zinc-oxide eugenol paste, Addition silicone two parallel reference lines A and C was measured at scale and a vernier scale which were attached (polyvinylsiloxane), Polyether elastomer, Impression two fixed points. These reference points were scribed together and with the help of vernier scale it was compound, Impression plaster of paris, Acrylic resin, in the metallic die and were copied in the sample possible to measure up to 10 micrometer i.e. 0.01 Thermoplastic resin, Alginate (irreversible hydrocol- during their fabrication. millimeter. The two reference points between the loid), Condensation type silicone, Eugenol free zinc For polyvinylsiloxane specimen: vertical parallel line were measured through a magni- oxide eugenol paste4,5,6. Intercclusal recording mate- Two equal length of base and catalyst according to fying tube attached with the traveling micrometer rials are basically similar to impression materials but the manufacturers recommendation and kneaded microscope. At first reference point A1 was placed GroupA: polyvinylsiloxane; n:Total number of sample are modified to give good handing characteristics4. with clean finger instead of wearing latex gloves to beneath the magnifying tube on the platform of the Table-I shows that mean±SD was 6.00±0.00 after Each of these has advantages and disadvantages as prevent sulfur contamination from these gloves which microscope. The measurement M1 was recorded by one hour follow up visit 5.97±0.38 after 24 hours, interocclusal recording materials. In Bangladesh inhibits the setting of the addition silicone interocclu- the following formula. M1= (Reading of millimeter 5.92±0.04 after 48 hours and 5.82±0.04 after 72 most popular interocclusal recording materials are sal recoding material and may produced major distor- scale + Reading of vernier scale x vernier constant i.e hours follow up visit. It was indicated that maximum alginate5. Alginate has limitation but it also has some tion. Then kneaded material together (approximately 0.01) mm. Then the platform was horizontally moved horizontal distance between A & C after one hour advantages too over the other materials that make it 45 seconds) until a uniform, streak free color was without shifting the sample and with the help of rotat- follow up visit and minimum horizontal distance more valuable. Because of its extreme fluidity before achieved. It was then placed on the surface of the die ing the platform screw. Now reference point C1 was between A & C after 72 hours follow up visits. setting and its resilency after setting, alginate causes for impression making. fixed under the magnifying tube. The measurement Table II: Distribution horizontal distance in different minimal tooth and tissue displacement when occlusal For alginate specimen: M2 was measured by the same formula. Measure- follow up of group B registrations are made with it5. Posselt thought that For mixing alginate powder and water were meas- ment of the distance between A & C parallel lines at alginate records were superior to wax, but shrinkage ured according to the manufacturer’s recommenda- reference point between A1C1 is done by subtracting made them useless after a few minutes7. The dimen- tion at room temperature. The measured powder M1 from M2. So A1C1=M2-M1. In the same way, sional stability of interocclusal recording materials (9gm) was shifted into premeasured water (17ml) that horizontal distance between A2_C2 was measured. over time is of utmost importance, as it ensures a had already been poured into a clean rubber bowl. The mean of two readings were used for calculation more accurate representation of the patient's maxillo- The powder was incorporated into the water by care- for each sample. Reading was recorded for all 10 mandibular relationship10. So the study was done to fully mixing. Mixing time (30 seconds) was carefully samples of each group at intervals of 1 h, 24h, 48h & compare the dimensional stability of polyvinylsilox- maintained and after that it was placed on the surface 72 hours. The measurement data was collected from ane and alginate at various times of intervals (1h, 24 of the die for impression making. samples of each group and was recorded in data hs, 48 hs, 72 hs). Sample collection: collection sheet. Horizontal linear distance between Group B : Alginate; n:Total number of sample After homogenous mixing, the materials were carried A1 C1 and A2 C2 is measured in millimeters. Table-II shows that mean±SD was 5.68±0.05 after Materials & Methods to the die. The stainless steel die was inverted on to a Statistical analysis: one hour follow up visit, 5.56±0.02 after 24 hours, Introduction lation. In these situations, the patients’ interocclusal This comparative in vitro study was carried out 4x4 inch square glass plate covered with polyethyl- Data analysis was done by using computer based 5.49±0.03 after 48 hours and 5.41±0.06 after 72 Inter occlusal records are the means whereby inter records are made and sent along with the cast to the Department of Prosthodontics, BSMMU, Dhaka, from ene sheet. Hand pressure was applied for about five program SPSS (Statistical Package for Social hours follow up visit. It was indicated that maximum arch relationship are transferred from mouth to an laboratory. This requires that the records must be June 2009 to 2010. Duplicated disk of polyvinylsilox- seconds initially to express the materials followed by Sciences) version 12. Paired t test was done to find horizontal distance after one hour follow up visits and articulator1. Maxillomandibular records are necessary dimensionally stable for the given period of time ane and alginate obtained from custom made stain- application of a 500 g weight to further remove of out statistical significance value. The results were minimum after 72 hours follow up visits. 2 to study the status of the dentition and to construct before they are used to articulate the casts . Record- less steel die were used as a sample. The sample excess materials. Each assembly remains for the presented in tables and figures. The result of signifi- Table III: Comparison of horizontal distance in group dental restoration. One type of record is used for ing maxillomandibular relationship is an important size of the study was twenty. Only freshly prepared manufacturer suggested setting time ie alginate for 2 cance was expressed as p value. P value <0.05 was A and group B mounting casts of the teeth or setting the articulator step in oral rehabilitation. This relationship is trans- duplicated disks from die were selected. minutes 20 seconds and additional three minutes to considered as significant. adjustments and another for appraising the degree of ferred to the articulator so laboratory procedure done Group of sample: ensure polymerization of materials. The mold assem- occlusal or incisal tooth contacts2. Adequate laborato- on the cast will be corresponding with patients’ Group A: 10 disks were made with polyvinylsiloxane. bly was removed from the stainless steel die and all Results 3 ry facilities are commonly not available locally and mouth . To create a harmonious occlusion, it is Group B: 10 disks were made with alginate. excess materials were trimmed. Samples were stored The present in vitro study was intended to compare casts have to be sent to others laboratories for articu- essential to record the existing maxillomandibular Preparations of stainless steel die: in room temperature. Later specimens were prepared the dimensional stability of polyvinylsiloxane and The stainless steel die had two portions: a round in the form of a disk measuring 3cm in diameter with alginate at various times of intervals. Total 20 sam- stainless steel test block and a stainless steel ring4 three parallel lines on the surface. ples were evaluated. The findings of the study that fits around the borders and acts as a mold for the Measurement of the test samples: obtained were analyzed and presented below. specimen. A round stainless steel die was construct- These three lines were named A, B & C which were ed for testing dimensional change. Three parallel equally separated by a distance of 3 mm. The lines were included on the die surface. These three distance between the two parallel reference lines, A & C, were measured at two fixed points (A1C1 and Group A polyvinylsiloxane, Group B Alginate, The mean lines were named A, B and C which were equally difference is considered significant if p< 0.05. * Significant separated by a distance 3 mm. The stainless steel A2C2). These reference points were scribed in the

Update Dental College Journal Vol. 7 No. 1 | April 2017

Table-III shows that after 1 hour follow up visit Conclusion (RTC) were the most frequent cause of facial energy trauma causing maxillofacial injury are high the Oral and Maxillofacial surgery Department. Figure 1: Sex distribution of the patients (n=60) Table 3: Distribution of fracture facial bones (n=60) Table-5: Cross tabulation between pattern of facial 8.09:112. This indicates that males are more prone to beaten by her male partner and/or family members mean±SD was 6.00±0.00 in group A and mean±SD In this study we concluded that dimensional stability injuries7,8 However more recent studies have shown enough to cause concomitant head injury1,2,3,4. The fracture and severity of head injury (n-60) maxillofacial injury with or without head injury this for dowry for other reasons. We found only 1.7% in was 5.68±0.05 in group B. After 24 hours follow up is influenced by both Material and time factors. It that assault is now the most common cause of maxil- purpose of this study was to evaluate the pattern of Statistical analysis high vulnerability of male gender for all type of trauma our study. visit mean±SD was 5.97±0.08 in group A and decreased as the time factor is increased. Polyvinyl- lofacial injuries in developed countries9,10 where as head injuries in Patients with maxillofacial trauma and After the patient had given consent to be included in can be attributed to the fact that in our society males Isolated mandible fractures are most common facial mean±SD was 5.56±0.02 in group B. After 48 hours siloxane were dimensionally more stable than traffic accidents remain the most frequent cause in to co relate the relationship between them. the study, a standardized structured data collection are predominantly the bread bearing for the family. bone to be fractured ranging from 12.9% to as high as follow up visit mean±SD was 5.92±0.04 in group A alginate interocclusal material. many developing countries11 like Bangladesh. Others sheet was used to collect necessary information of Moreover they are at higher risk of injuries than 72.9%, followed by midface ranging from 25.9% to and mean±SD was 5.49±0.03 in group B. After 72 causes of maxillofacial trauma are fall from height, Material and methods: the study subject. The data were screened and women because of their greater exposure of automo- 29.5%11,12,21 the other frequently affected bones are hours follow up visit mean±SD was 5.82±0.04 in References assaults, altercation, pedestrian injury, home and This was a descriptive type of cross-sectional study checked for any missing value and discrepancy. The bile and motorcycle accident and engaged in more the floor of the orbit and nasal bones. However, in the group A and mean±SD was 5.41±0.06 in group B. industrial accidents and athletic injuries, in descend- carried out at the department of Oral & Maxillofacial data were then processed and analyzed using statis- risky behavior like hanging on the side of the bus or present series, the most frequent maxillofacial injury 12 The difference was statistically significant (P<0.05) 1. Skurnik H. Resin registration for interocclusal recods. J ing order of frequency . Surgery, Bangabondhu Sheikh Mujib Medical Univer- tical software SPSS (statistical Package for Social rush to get in a running bus. represented was the fractured mandible 36.6%, between group A and group B in different follow up ProsthetDent.1977;21(2):164-170. The peak age of incidence of maxillofacial injuries sity, Shahbag, Dhaka. The period of study was from Science) version16. Chi- square test was carried out In our study, it was found that majority of patients followed by fractured Zygomatico-maxillary complex visits. among 21 -30 years13 and more males are involved in 1st May 2010 to 30th April 2011. The patient’s data and significant level p value of < 0.05 was considered were in the age group between 2nd to 4th decade including orbit and Lefort fractures. In a survey by 2. Dua MP, Gupta SH, Ramachandran S, Sandhu HS. maxillofacial injuries than females14. Children are were collected from Inpatient department of Neuro- statistically significant. The summarized data were and mean age was 29.63 years which is similar to Malara P et ai in 2006, they found in 198 patients that Fig-1: Shows that among patients with both maxillofacial Discussion Evaluation for four elastomeric interocclusal recoding mate- uniquely susceptible to maxillofacial injury because of surgery, Dhaka Medical College &Hospital and inpa- present in the form of tables, graphs and bar other studies of the globe.21 The possible explanation 18.69%suffered mandibular fracture, 12.63% Zygo- rials. MJAFIl. 2007 ;63 (3) : 237-240. 15 and head injury 88.3% were male and 11.7% were female. The linear dimensional changes of two interocclusal their disproportionate cranial-body mass ratio . tient department of Oral and Maxillofacial Surgery, diagrams by the help of statistician. S = Significant for this is that the people in this age group take part in matic complex fracture and 12.2% maxillary Patients older than 65 years account for approxi- dangerous exercise and sports, drive motor vehicles fractures22. Obuekwe and Etetafia in 2004 found in recording materials were measured over time in this 3. Tripodakis AP, Vergos VK, Tsoutsos AG. Evaluation of Bangabondhu Sheikh Mujib Medical University, Table 2: Distribution of mode of injury (n=60) Table-3: Shows mandible was the most commonly Table-5: indicates that most of the zygomatic- maxillary study. These measurements provided an indication of the accuracy of interocclusal records in relation to two mately 1% of maxillofacial trauma, and falls on a Shahbag, Dhaka who were referred from other Results and Observation: fractured facial bone (36.67%) (n=22) at different anatomi- complex fracture including orbit occurred in case of moder- carelessly and are more likely to be involved in their study, that mandible was the most common site the dimensional stability of those materials. However, recording techniques. J Prosthet Dent.1997; 77 (2): slippery ground is the most common cause in this age Neurosurgical center. The total of 60 patients who cal locations. Both Zygomatico-maxillary complex fracture ate head injury and most of the Lefort-II fracture occurred in violence. Patients less than 10 years and more than of fracture, followed by Zygomatic complex and max- 16 23 dimensional stability can also be studied in all the 141-146. group . sustained both cranial and facial injuries were includ- Table-1: Age distribution of the study subjects (n=60) and Lefort-II fracture were equal frequency 18.3% (n=11). patients with moderate and severe head injury. And most of 60 years were less frequently affected in our series. illa . The results of our study therefore correlate with three planes using equipments like the condymeter, It was evident that the facial bones fractures were ed in this study. After taking informed consent, data the Lefort-III fracture occurred in patient with severe head These could be explained that children are usually other literatures. computerized Axitron and Buhnergraph4. Table 1 4. Karithikeyan K, Annapumi. Comparative evaluation of uncommonly singular with compound and comminut- were collected by history, through clinical examina- Table-4: Distribution of involvement of cranium (n=60) injury. taken care of by elders during travelling and lesser In this study we found among LeFort fractures shows group A exhibited no significant difference dimensional stability of three types of interocclusal record- ed nature adding on to the complexity of facial tion, radiographic evaluation and Neurosurgical mobility of geriatric people. But the effect of head LeFort- ll is more common (18.3%), than LeFort lll Graph 3: Correlation between pattern of facial fracture between the die scribe and those of the sample at the ing materials: an in vitro study. Journal of Indian Prostho- fractures. It is a common concept of fracture nasal consultation. Appropriate skull X-Rays were done in injury is disproportionately severe in elderly and they (11.7%) and LeFort – l. The pattern is identical to dontic Society.2007; 7(1) :24-27. and severity of head injury 15 immediate reading. Nisan et al2 observed that addi- bone being the most common facial bone to be all patients and patients with impaired conscious- require more neurosurgical care. studies conducted by Haug HR, Foss J. in 2000 . tion type silicone, polyvinyl siloxane is most accurate fractured, then the zygoma followed by mandible and ness, neurological sign or clinical sign of basal skull The main causes of craniofacial injury worldwide are Our results demonstrated lower incidence of Nasal 5. Scott WR .Occlusal registration using alginate (irreversi- 17 and stable interocclusal recording material. Table II ble hydrocolloid) impression material.J Prosthet Dent. maxilla. fracture, an initial CT scan was also performed. assaults and road traffic accidents, but the preva- bone fracture (5%), although it is a common concept shows in group B the same result. Table III shows 1978;40(5) :51 7-519. Apart from maxillofacial injury, high velocity impacts Information regarding age, gender, cause of injury, lence varies depending on the demographics and of fracture Nasal bone is the most frequent facial comparison of horizontal distance between group A may result in fracture of facial bones and life threaten- pattern of facial and/or head injuries, loss of geography of the area. Road traffic accidents (RTA) bone to be fractured. It probably comes from the fact and group B. The difference was statistically signifi- 6. Lassila V. Comparison of five interocclusal recording ing intracranial hemorrhages in different compart- consciousness, and GCS score were obtained and Table 2: indicates that majority of the victims suffered by are the commonest cause of craniofacial trauma in that isolated Nose fracture was managed by other cant (p<0.05) of all follow up visit between group A material. J Prosthet Dent.1986 ; 5: 215-218. ments requiring urgent neurosurgical intervention19. A recorded in questionnaires. motor vehicle accidents (60%), (n=36) followed by fall from most of the series5,11,12,20 and this occurred largely in specialties like ENT and Plastic Surgery. height (13.3%) (n=8) and pedestrians (11.7%), (n=7). and group B. Above reports showed similar results8. decrease in the level of consciousness is the single The causes of injury were summarized as follows: our circumstance also (60%) because of reckless- GCS is a good marker for determining potential brain Some researchers carried out an experimental9 study 7. Eriksson A, Eriksson GO, Lockowandt P, et al .Materials most reliable indicator that the patient has a serious Motor vehicle accidents, Fall from height, Pedestrian, ness and negligence of the drivers, poor mainte- injury, clinical conditions and prognosis of the patients for reliable interocclusal measurements. Br Dent J.2002 20 Graph 2: Distribution of Glasgow Coma Score (GCS) 24 and found that addition silicone presented smaller head injury or secondary insult to the brain . Loss of Assault, Sports injuries, Work-related injuries, and Mean ± SD = 29.63±12.0 Range = (5 - 64 years) nance of vehicles, often driving under the influence of following trauma . On the basis of GCS scores of the ;192 (7) : 385-400. intracranial hemorrhages, closed head traumas Majority of the victims were in the age group of 21 to of the patients (n=60) linear when compared to alginate. Moisture, especial- Introduction: consciousness is the manifestation of intracranial others. Table- 4: indicate that Linear fracture were more (31.6%) alcohol or drugs and complete disregard of traffic patients, It was found that, majority of patients with Maxillofacial trauma and concomitant head injuries (brain contusion or laceration), or fractures. General- 40 years (75%), with 21-30 years (51.7%) more ly, can cause considerable dimensional changes in 8. Lassila V, McCabe JF. Properties of interocclusal regis- injury or concussion head injury (62%), followed by Facial injuries included facial bone fractures and/or (n=19) then depressed fracture (n=16) and scalp injury. laws. Fall from height was the second most common head injury according to their GCS score were classi- carry the significant potential for mortality and neuro- ly, the presence of emesis, vomiting, loss of affected among this group. Children less than 10 yrs alginate. Therefore great care is taken wrapping and tration materials.J Prosthet Dent. 1985; 53: 100-104. headache (33%), vomiting (27%), nasal bleed (30%) soft tissue injuries. Facial bone fractures were classi- Discussion: cause of injury in our series and attributed to 13.3%, fied as having moderate head injury 55% (n=33), consciousness, or a low Glasgow Coma Scale (GCS) 21 and elderly >60yrs of age made up a less frequency. packaging them during storage and transfer. Few logical morbidity. Maxillofacial trauma can occur as and oral bleed (10%) . fied as mandibular, Lefort I, Lefort II, Lefort III, Zygo- Figure-2: Distribution of type of head injury (n=60) Bangladesh is a south Asian developing country this occurred mostly in urban area where lot of followed by severe head injury 20% (n=12),mild head score are important findings for suspicion of a cranial authors have suggested ideal times for articulation of 9. John J, Manapallil. Basic Dental Materials. 2nd ed .New an isolated injury or in combination with other severe The Glasgow Coma Scale score(GCS) is used to matico-maxillary fracture including orbit, and Nasal where poverty and unemployment forcing the people peoples worked as a day labour in construction of injury 15% (n=9), and minor head injury 10% (n=6) 1 injury. However, in patients with maxillofacial trauma, Graph 1: Age Distribution of the study subject (n=60) casts with respect to the type of interocclusal records Delhi: Jaypee Brothers medical publishers (p). Ltd.2003 : injuries . Patients with maxillofacial trauma may pres- quantify neurologic findings and it is widely accepted bone fractures. The types of mandibular fractures towards urban areas. This rapid and unplanned high rise buildings and painting them. It is in accord- respectively. The results from this study showed a head trauma may also be seen without observing the used. The result of this present study was consistent 58. ent with associated intracranial, pulmonary, intra-ab- and a standardized method for evaluating level of were classified by anatomic site (condyle, ramus, urbanization associated with incompetent traffic ance with others findings from South India, which significantly higher incidence of moderate type of 2,3 suggestive findings6. with the above study. Thus, it becomes mandatory to dominal or extremity injuries . A close relationship consciousness depending on the score of the GCS angle, body, symphysis, parasymphyses and coro- system, unplanned roads and highways, violation of reported 16,6% of Craniofacial trauma were due to head injuries associated with maxillofacial injuries as 10. Michalakis KX, Argiris P, Vassiliki A. Experimental The etiology of maxillofacial injuries varies from one 12 choose a material depending not only on the clinical between maxillofacial fracture and intracranial injury head injury can be classified as very mild, mild, mod- noid). traffic laws by the drivers and pedestrian injury, over- fall from coconut tree. In our study, we found, compared to other reports in the English literature. study on Particular Physical Properties of several Interoc- 4-6 country to another and even within the same depend- situation but also on the time taken for the articula- has been reported in many articles . In many coun- erate and severe head injury. About intracranial Head injuries included skull fractures and/or intracra- crowding, etc are responsible for highest figure of pedestrians constituted 11.7% of the total victims. In In case of head injury, various pattern of skull fracture clusal Recording Media. Part II: Linear Dimensional tries, cranial injury has been found to be the most ing on the prevailing socioeconomic, cultural and tion. From above study I found that dimensional Change and Accompanying Weight Change. Journal of lesions, contusion/ concussion, extradural hemato- nial injuries. Skull fractures were classified into scalp road traffic accidents, and these RTA victims are Dhaka city, a large number of pedestrians are were found. Linear fracture was the commonest type common accompanying organ injury in patients with environmental factors. Earlier studies from Europe changes of polyvinylsiloxane inter occlusal recording Prosthodontics. 2004 ;13(3) :150-159. ma, subdural hematoma, subarachnoid hematoma injury, linear fracture and depressed fracture of mainly suffered from Craniofacial injury. garments employees and day labor. They have lack (31.6%) followed by depressed fracture (26.6%). 3,4 and America revealed that Road Traffic crashes material was not significant in a horizontal plane after maxillofacial trauma . These includes head traumas, and intracerebral haematoma occurs most frequent- frontal, temporal, parietal, occipital, and basal skull Above figure indicates that most of the study population In the present study, majority of the head and of knowledge regarding traffic rules, shortage of Linear fracture was the commonest one because 20 1 and 24 hours. The changes after 48 and 72 hours ly . fractures. Intracranial injuries were summarized as suffered from moderate head injury (55%), (n=33), followed concomitant facial injuries were experienced by space in footpath, most of which are occupied by the during RTA head strikes by forcible contact with broad were lesser than other group. So it can be concluded Existing literature on the correlation of traumatic head concussion, cerebral contusion, and intracranial by severe head injury (20%) (n=12), mild head injury (15%), hawkers. Most of the pedestrians are not used to use resting surface like roads18. This result was identical (n=9) and very mild head injury (10%) (n=6). males, constituted 88.3% and females constituted that polyvinylsiloxane is more dimensionally stable injuries and maxillofacial trauma Is highly controver- hemorrhage (epidural, subdural, intracerebral and the pedestrian’s bridge. That’s why pedertrain injury to other study done by Ahmed et al in 2009 in Bang- Above figure indicates that, most of the study population only 11.7% of the total victims. The male to female sial. Some suggest that it is the facial skeleton that is a common cause of injury in our country. Domestic ladesh.20 Regarding depressed fracture of individual interocclusal recording materials than alginate. subarachnoid). Above graph indicates that 21-30 years age group was suffered from contussion (35%) (n=21). 18.3% had ratio was 7.57:1. These results are similar in a study absorbs the energy of the trauma, protecting the Brain trauma was handled by Neurosurgery depart- more commonly affected. subdural hemorrhage (n=11) and 15% had Extradural from India, where 89% of subjects were males and violence is another cause of craniofacial trauma in bones, Frontal was most prone to fracture (16.66%) brain from injury, whereas, others suggest that high ment and complex facial fractures were repaired by haemorrhage (n=9). 11% were females, giving a male to female ratio our country, where the women are most of the time followed by fracture temporal bone (5%) and parietal

18

bone. This coincides with other study done previously closed head injuries than mandible fracture.19 These with panfacial fractures. J Trauma. 2007; 63:831-5. 16. Rehman K, Edmcndson H. The causes and conse- at BSMMU in Bangladesh in 2002.25 difference in the facial bone or head injury being stud- quences of maxillofacial injuries in elderly people. Gero- In agreement with a study by Pappachan and Alexan- ied and the variation in classification, nomenclature 3. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associ- dontology. 2002; 19:60-64. der, we observed that CSF rhinorrhoea was nearly or methodology of prior studies may explain these ated injuries in facial fractures: review of839 patients. Br J Plast Surg. 1993;46:635-8. 17. Khan AR, Arif S. Ear nose and throat injuries in children. twice as frequent as CSF otorrhoea.27 This may be conflicting result. In the present study we demonstrat- J Ayub Med Coll Abbottabad.2005; 17:54-6. explained by the fact that anterior Cranial base is ed that LeFort- lll fracture was the strongest predic- 4. Mulligan RP, Friedman JA, Mababir BC. A nationwide relatively closer to midfacial structures and has more tor of severe head injury, followed by LeFort- ll and review of the associations among cervical spine injuries, 18. Davidoff G, Jakubowski M, et al. The spectrum of sutural connection with midfacial bones compared to Zygomatico-maxillary fracture including Orbit this head injuries, and facial fractures. J Trauma. closed- head injuries in facial trauma victims:incidence and the middle cranial base. Thus, the chance of anterior coincide with the other findings done by Kloss et al. 2010;68:587-92. impact. Ann Emerg Med.1998; 17:6-9. cranial base fracture and resulting CSF rhinorrhoea is reported that LeFort- lll fracture was the strongest expected to be higher. predictor of intracranial bleeding. 5. Gwyn PP, Carraway JH, Horton CE, Adamson JE, 19. Egol R, Fromm KR, et al. Guideline for intensive care Similar to other studies the most common neurologi- Mladick BA. Facial fractures-associated injuries and unit admission, discharge, and triage. Cr/f Care Med 1992; complications. Plast Reconstr Surg. 1971;47:225-30. 27:633-638. cal symptom was loss of consciousness, which can Conclusion be manifestation of intracranial injury or concussion Adult males in the age group of 20-40 years were the 18,24 6. Kloss F, Laimer K, Hohlrieder M, Ulmer H, Hacki W, 20. Ahmad M, Rahman FN, Chowdhury MH, et al. Postmor- head injury which was also more common in most common victims of craniofacial trauma. Road Benzer A, et al. Traumatic intracranial haemorrhage in tem study of head injury in fatal road: traffic accidents. 21,24 patients with fracture of the upper face moreover traffic accidents were responsible for the majority and conscious patients with facial fractures-a review of 1959 JAFMC.2009; 5 :(2):24-28. loss of consciousness is less common with isolated most of the patients sustained moderate head injuries cases. Craniomaxillofac Surg. 2008;36:372-7. facial fractures. Gwynn et al found that life threaten- that were then managed conservatively. Fracture 21. Pradeep G, Ankit J, Nirmal K G. Association of Head ing injuries such as cerebral concussion were mandible was the most common maxillofacial injury 7. Adeyemo WL, Ladeinde AL, Ogunlewe MO, James injury and Maxillofacial Trauma: A prospective Case- frequently associated with facial fractures26 which .More severe were the maxillofacial injury more were O.Trends and characteristics of oral and maxillofacial Control study. Indian journal of Applied Research. 2016; support the result of our study. We found that 35% the chances of neurological injury. Fracture of the injuries in Nigeria: a review of the literature. Head Face 6(3): 528-531. Med. 2005; 1:7. patient had cerebral contusion. But at the same time, mid-face was found to be most commonly associated 22.Malara P, Malara B et al:characteristics of maxillofacial as in present series, all patients who sustain moder- with head injury and the management of both neuro- 8. Van Hoof RF, Merkx CA, Stekelenburg SC. The different trauma resulting from road traffic accidents- a 5years ate or severe head injury also, had associated intrac- logical and maxillofacial injury was done according to patterns of fractures of the facial skeleton in four European review. Head and Face medicine. 2006:2:27. ranial injuries reflecting the severity and complexity of the necessity. countries. Int J Oral Surg.1977; 6 (1): 3-11. craniofacial trauma.18 23.Obuekwe ON, Ojo MA, Akpata O. Maxillofacial trauma Apart from maxillofacial fractures, high velocity Recommendations: 9. Brown RD. Cowpe JG. Patterns of maxillofacial trauma in due to road traffic accidents in Benin City, Nigeria: A impacts may result in ruptures of intracranial vessels, In view of the high association of closed head injury in two different cultures: Acomparison:between Riyad and prospective study. Annals of African Medicine. 2003; 2(2): leading to life-threatening intracranial hemorrhage, the facial fracture population, as well as high potenti- Tayside. JR Coil surg Edinb.1985; 30(5): 299-302. 58-63. Intracranial hemorrhage was found in 45% cases in ality for mortality and neurological morbidity the present study, which was more as compared to previ- 10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture 24. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A authors of present study recommend the routine use patterns: A suburban trauma center experience. An J review of 100 closed head injuriesassociated with facial ous studies28.This may be due to the difference in the of head CT for all patients sustaining a facial trauma Otolaryngol. 2004; 25 (5): 301-307. fractures. J Oral Maxillofac Surg. 1992;50:218-22. mode and severity of injuries. and close monitoring of neurological status of these About intracranial lesions most of the victims had patients. 11. Ansari MH. Maxillofacial fractures in Hamedan provi- 25. Chowdhury D. Depressed skull fractures: analysis of subdural haemorrhage 18.3%, followed by extradural ence, Iran: A retrospective study (1987-2001). J Cranio- clinical outcome and cost effectiveness of timely surgical haemorrhage (15%), and subarachnoid haemor- Consent for the study maxilloac Surg.2004; 32 (I): 28-32. management. MS (Neurosurgery) thesis, BSMMU, 2002. rhage (11.7%). In a study from India by Ashok KG et • All patients or relatives were given a necessary 12. Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. 26. Gwynn P, Carraway JH, Horton CE, et al: Facial al, showed that 5% victims had subdural haemor- explanation about the study before they asked to Characteristics of associated trauma in patients with head fractures-associated injuries and complications. Plast and rhage 14% had subarachnoid haemorrhage and 13% participate. had extradural haemorrhage14 which is identical to injuries: An experience with 100 cases. J Trauma and Reconstr Surg. 1971; 47: 225-230. • For those patients who were unconscious, consents Shock. 2009; 2(2): 89-94. our study. were obtained from their relatives. 27. Pappachan B,Alexander M. Correlating facial fractures The results of previous studied evaluating the • For patients under ages 18 years, informed 13. Adekeye SO. The pattern of fracture of facial skeleton in and Cranial Injuries. J Oral Maxillofacial Surg. 2006; relationship between facial and head injuries are consents were obtained from their parents/ guardi- Kaduna Nigeria. A survey of 1447 cases. Oral Surg. 1980; 64:1023-1029. conflicting. Hohlrieder et al reported that Le Fort- ll ans. 49(6): 491- 495. and lll, Orbit, Nose,, Zygoma and Maxillary fractures 14. Ashok KG, Ran’ineesh G, Asish C. A retrospective 28. Zandi M, HoseiniSR. The relationship between head were associated with a 2-to 4 fold risk of intracranial analysis of 189 patients of maxillofacial injuries presenting injury and facial trauma: a case- control study. J oral and References: to a tertiary care hospital in Punjab, India. J Maxillofac Oral maxillofacial surgery. 2013; 7(3):201-207. hemorrhage, while mandibular fracture did not signifi- 1. Sharmin FN, Cameron P et al. Maxillofacial trauma in Burg. 2009; Sep;8(3):241-5. cantly increases the chance of intracranial hemor- major trauma patients. Aus Den Journ. 2006; rhage21. Haug et al. reported that although the mandi- 51(3):225-230. 15. Haug RH, Foss J. Maxillofacial injuries in the pediatric ble was the most frequent fractured bone in patients patient. Oral Surg Oral Med Oral Pathol of Oral Radio 2. Follmar KE, Debruijn M, Baccarant A, Bruno AD, Muku- with concomitant facial and head injuries, midface Endod. 2000; 90:126-134. fractures were more frequently associated with ndan S, Erdmann D et al Concomitantinjuries in patients (RTC) were the most frequent cause of facial energy trauma causing maxillofacial injury are high the Oral and Maxillofacial surgery Department. Figure 1: Sex distribution of the patients (n=60) Table 3: Distribution of fracture facial bones (n=60) Table-5: Cross tabulation between pattern of facial 8.09:112. This indicates that males are more prone to beaten by her male partner and/or family members injuries7,8 However more recent studies have shown enough to cause concomitant head injury1,2,3,4. The fracture and severity of head injury (n-60) maxillofacial injury with or without head injury this for dowry for other reasons. We found only 1.7% in that assault is now the most common cause of maxil- purpose of this study was to evaluate the pattern of Statistical analysis high vulnerability of male gender for all type of trauma our study. lofacial injuries in developed countries9,10 where as head injuries in Patients with maxillofacial trauma and After the patient had given consent to be included in can be attributed to the fact that in our society males Isolated mandible fractures are most common facial traffic accidents remain the most frequent cause in to co relate the relationship between them. the study, a standardized structured data collection are predominantly the bread bearing for the family. bone to be fractured ranging from 12.9% to as high as many developing countries11 like Bangladesh. Others sheet was used to collect necessary information of Moreover they are at higher risk of injuries than 72.9%, followed by midface ranging from 25.9% to causes of maxillofacial trauma are fall from height, Material and methods: the study subject. The data were screened and women because of their greater exposure of automo- 29.5%11,12,21 the other frequently affected bones are assaults, altercation, pedestrian injury, home and This was a descriptive type of cross-sectional study checked for any missing value and discrepancy. The bile and motorcycle accident and engaged in more the floor of the orbit and nasal bones. However, in the industrial accidents and athletic injuries, in descend- carried out at the department of Oral & Maxillofacial data were then processed and analyzed using statis- risky behavior like hanging on the side of the bus or present series, the most frequent maxillofacial injury ing order of frequency12. Surgery, Bangabondhu Sheikh Mujib Medical Univer- tical software SPSS (statistical Package for Social rush to get in a running bus. represented was the fractured mandible 36.6%, The peak age of incidence of maxillofacial injuries sity, Shahbag, Dhaka. The period of study was from Science) version16. Chi- square test was carried out In our study, it was found that majority of patients followed by fractured Zygomatico-maxillary complex among 21 -30 years13 and more males are involved in 1st May 2010 to 30th April 2011. The patient’s data and significant level p value of < 0.05 was considered were in the age group between 2nd to 4th decade including orbit and Lefort fractures. In a survey by maxillofacial injuries than females14. Children are were collected from Inpatient department of Neuro- statistically significant. The summarized data were and mean age was 29.63 years which is similar to Malara P et ai in 2006, they found in 198 patients that Fig-1: Shows that among patients with both maxillofacial uniquely susceptible to maxillofacial injury because of surgery, Dhaka Medical College &Hospital and inpa- present in the form of tables, graphs and bar other studies of the globe.21 The possible explanation 18.69%suffered mandibular fracture, 12.63% Zygo- 15 and head injury 88.3% were male and 11.7% were female. their disproportionate cranial-body mass ratio . tient department of Oral and Maxillofacial Surgery, diagrams by the help of statistician. S = Significant for this is that the people in this age group take part in matic complex fracture and 12.2% maxillary 22 Patients older than 65 years account for approxi- Bangabondhu Sheikh Mujib Medical University, Table 2: Distribution of mode of injury (n=60) Table-3: Shows mandible was the most commonly Table-5: indicates that most of the zygomatic- maxillary dangerous exercise and sports, drive motor vehicles fractures . Obuekwe and Etetafia in 2004 found in mately 1% of maxillofacial trauma, and falls on a Shahbag, Dhaka who were referred from other Results and Observation: fractured facial bone (36.67%) (n=22) at different anatomi- complex fracture including orbit occurred in case of moder- carelessly and are more likely to be involved in their study, that mandible was the most common site slippery ground is the most common cause in this age Neurosurgical center. The total of 60 patients who cal locations. Both Zygomatico-maxillary complex fracture ate head injury and most of the Lefort-II fracture occurred in violence. Patients less than 10 years and more than of fracture, followed by Zygomatic complex and max- 16 23 group . sustained both cranial and facial injuries were includ- Table-1: Age distribution of the study subjects (n=60) and Lefort-II fracture were equal frequency 18.3% (n=11). patients with moderate and severe head injury. And most of 60 years were less frequently affected in our series. illa . The results of our study therefore correlate with It was evident that the facial bones fractures were ed in this study. After taking informed consent, data the Lefort-III fracture occurred in patient with severe head These could be explained that children are usually other literatures. uncommonly singular with compound and comminut- were collected by history, through clinical examina- Table-4: Distribution of involvement of cranium (n=60) injury. taken care of by elders during travelling and lesser In this study we found among LeFort fractures

ed nature adding on to the complexity of facial tion, radiographic evaluation and Neurosurgical mobility of geriatric people. But the effect of head LeFort- ll is more common (18.3%), than LeFort lll fractures. It is a common concept of fracture nasal Graph 3: Correlation between pattern of facial fracture injury is disproportionately severe in elderly and they (11.7%) and LeFort – l. The pattern is identical to consultation. Appropriate skull X-Rays were done in and severity of head injury bone being the most common facial bone to be all patients and patients with impaired conscious- require more neurosurgical care. studies conducted by Haug HR, Foss J. in 200015. fractured, then the zygoma followed by mandible and ness, neurological sign or clinical sign of basal skull The main causes of craniofacial injury worldwide are Our results demonstrated lower incidence of Nasal maxilla.17 fracture, an initial CT scan was also performed. assaults and road traffic accidents, but the preva- bone fracture (5%), although it is a common concept Apart from maxillofacial injury, high velocity impacts Information regarding age, gender, cause of injury, lence varies depending on the demographics and of fracture Nasal bone is the most frequent facial may result in fracture of facial bones and life threaten- pattern of facial and/or head injuries, loss of geography of the area. Road traffic accidents (RTA) bone to be fractured. It probably comes from the fact ing intracranial hemorrhages in different compart- consciousness, and GCS score were obtained and Table 2: indicates that majority of the victims suffered by are the commonest cause of craniofacial trauma in that isolated Nose fracture was managed by other ments requiring urgent neurosurgical intervention19. A recorded in questionnaires. motor vehicle accidents (60%), (n=36) followed by fall from most of the series5,11,12,20 and this occurred largely in specialties like ENT and Plastic Surgery. height (13.3%) (n=8) and pedestrians (11.7%), (n=7). decrease in the level of consciousness is the single The causes of injury were summarized as follows: our circumstance also (60%) because of reckless- GCS is a good marker for determining potential brain most reliable indicator that the patient has a serious ness and negligence of the drivers, poor mainte- injury, clinical conditions and prognosis of the patients Motor vehicle accidents, Fall from height, Pedestrian, Graph 2: Distribution of Glasgow Coma Score (GCS) head injury or secondary insult to the brain20. Loss of Assault, Sports injuries, Work-related injuries, and Mean ± SD = 29.63±12.0 Range = (5 - 64 years) nance of vehicles, often driving under the influence of following trauma24. On the basis of GCS scores of the intracranial hemorrhages, closed head traumas Majority of the victims were in the age group of 21 to of the patients (n=60) Introduction: consciousness is the manifestation of intracranial others. Table- 4: indicate that Linear fracture were more (31.6%) alcohol or drugs and complete disregard of traffic patients, It was found that, majority of patients with 40 years (75%), with 21-30 years (51.7%) more Maxillofacial trauma and concomitant head injuries (brain contusion or laceration), or fractures. General- injury or concussion head injury (62%), followed by Facial injuries included facial bone fractures and/or (n=19) then depressed fracture (n=16) and scalp injury. laws. Fall from height was the second most common head injury according to their GCS score were classi- ly, the presence of emesis, vomiting, loss of affected among this group. Children less than 10 yrs carry the significant potential for mortality and neuro- headache (33%), vomiting (27%), nasal bleed (30%) soft tissue injuries. Facial bone fractures were classi- Discussion: cause of injury in our series and attributed to 13.3%, fied as having moderate head injury 55% (n=33), consciousness, or a low Glasgow Coma Scale (GCS) 21 and elderly >60yrs of age made up a less frequency. logical morbidity. Maxillofacial trauma can occur as and oral bleed (10%) . fied as mandibular, Lefort I, Lefort II, Lefort III, Zygo- Figure-2: Distribution of type of head injury (n=60) Bangladesh is a south Asian developing country this occurred mostly in urban area where lot of followed by severe head injury 20% (n=12),mild head score are important findings for suspicion of a cranial an isolated injury or in combination with other severe The Glasgow Coma Scale score(GCS) is used to matico-maxillary fracture including orbit, and Nasal where poverty and unemployment forcing the people peoples worked as a day labour in construction of injury 15% (n=9), and minor head injury 10% (n=6) 1 injury. However, in patients with maxillofacial trauma, Graph 1: Age Distribution of the study subject (n=60) injuries . Patients with maxillofacial trauma may pres- quantify neurologic findings and it is widely accepted bone fractures. The types of mandibular fractures towards urban areas. This rapid and unplanned high rise buildings and painting them. It is in accord- respectively. The results from this study showed a head trauma may also be seen without observing the ent with associated intracranial, pulmonary, intra-ab- and a standardized method for evaluating level of were classified by anatomic site (condyle, ramus, urbanization associated with incompetent traffic ance with others findings from South India, which significantly higher incidence of moderate type of 2,3 suggestive findings6. dominal or extremity injuries . A close relationship consciousness depending on the score of the GCS angle, body, symphysis, parasymphyses and coro- system, unplanned roads and highways, violation of reported 16,6% of Craniofacial trauma were due to head injuries associated with maxillofacial injuries as The etiology of maxillofacial injuries varies from one 12 between maxillofacial fracture and intracranial injury head injury can be classified as very mild, mild, mod- noid). traffic laws by the drivers and pedestrian injury, over- fall from coconut tree. In our study, we found, compared to other reports in the English literature. 4-6 country to another and even within the same depend- has been reported in many articles . In many coun- erate and severe head injury. About intracranial Head injuries included skull fractures and/or intracra- crowding, etc are responsible for highest figure of pedestrians constituted 11.7% of the total victims. In In case of head injury, various pattern of skull fracture ing on the prevailing socioeconomic, cultural and tries, cranial injury has been found to be the most lesions, contusion/ concussion, extradural hemato- nial injuries. Skull fractures were classified into scalp road traffic accidents, and these RTA victims are Dhaka city, a large number of pedestrians are were found. Linear fracture was the commonest type environmental factors. Earlier studies from Europe common accompanying organ injury in patients with ma, subdural hematoma, subarachnoid hematoma injury, linear fracture and depressed fracture of mainly suffered from Craniofacial injury. garments employees and day labor. They have lack (31.6%) followed by depressed fracture (26.6%). 3,4 and America revealed that Road Traffic crashes maxillofacial trauma . These includes head traumas, and intracerebral haematoma occurs most frequent- frontal, temporal, parietal, occipital, and basal skull Above figure indicates that most of the study population In the present study, majority of the head and of knowledge regarding traffic rules, shortage of Linear fracture was the commonest one because 20 ly . fractures. Intracranial injuries were summarized as suffered from moderate head injury (55%), (n=33), followed concomitant facial injuries were experienced by space in footpath, most of which are occupied by the during RTA head strikes by forcible contact with broad Existing literature on the correlation of traumatic head concussion, cerebral contusion, and intracranial by severe head injury (20%) (n=12), mild head injury (15%), hawkers. Most of the pedestrians are not used to use resting surface like roads18. This result was identical (n=9) and very mild head injury (10%) (n=6). males, constituted 88.3% and females constituted injuries and maxillofacial trauma Is highly controver- hemorrhage (epidural, subdural, intracerebral and the pedestrian’s bridge. That’s why pedertrain injury to other study done by Ahmed et al in 2009 in Bang- Above figure indicates that, most of the study population only 11.7% of the total victims. The male to female sial. Some suggest that it is the facial skeleton that is a common cause of injury in our country. Domestic ladesh.20 Regarding depressed fracture of individual subarachnoid). Above graph indicates that 21-30 years age group was suffered from contussion (35%) (n=21). 18.3% had ratio was 7.57:1. These results are similar in a study absorbs the energy of the trauma, protecting the Brain trauma was handled by Neurosurgery depart- more commonly affected. subdural hemorrhage (n=11) and 15% had Extradural from India, where 89% of subjects were males and violence is another cause of craniofacial trauma in bones, Frontal was most prone to fracture (16.66%) brain from injury, whereas, others suggest that high ment and complex facial fractures were repaired by haemorrhage (n=9). 11% were females, giving a male to female ratio our country, where the women are most of the time followed by fracture temporal bone (5%) and parietal

Update Dental College Journal Vol. 7 No. 1 | April 2017 bone. This coincides with other study done previously closed head injuries than mandible fracture.19 These with panfacial fractures. J Trauma. 2007; 63:831-5. 16. Rehman K, Edmcndson H. The causes and conse- by using the fingernail. However, it starts to harden Results: Figure 1: Distribution of respondents according to χ2 =1.668, dƒ=4; p>0.05 the mothers (57%) did not know that the children about their oral health due to their lack of knowledge. at BSMMU in Bangladesh in 2002.25 difference in the facial bone or head injury being stud- quences of maxillofacial injuries in elderly people. Gero- within 48 hours, and in about 10 days the biofilm Table 1: Distribution of respondents according to Dental Plaque index. (n=386) Table-3 showed the relationship between frequency of the have to be assisted in cleaning their teeth till they As a consequence, they suffer from diverse of oral In agreement with a study by Pappachan and Alexan- ied and the variation in classification, nomenclature 3. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associ- dontology. 2002; 19:60-64. becomes hard and difficult to remove. This tarter socio demographic characteristics. (n=386) tooth brushing of the students and the dental plaque index. attained the age of seven [12]. In this case the effort of problems. Although some people have the practice of der, we observed that CSF rhinorrhoea was nearly or methodology of prior studies may explain these ated injuries in facial fractures: review of839 patients. Br J happens when biofilm is not removed by regular It was found that respondents brushed once daily had our mother towards children oral health is higher that tooth brushing but they apply wrong technique results Plast Surg. 1993;46:635-8. 17. Khan AR, Arif S. Ear nose and throat injuries in children. 66.0% mild dental plaque index whereas who brushed twice as frequent as CSF otorrhoea.27 This may be conflicting result. In the present study we demonstrat- brushing or flossing. Tooth brushing is the only way to prevails the higher consciousness of the Bangladeshi different kind of oral diseases and not reached the J Ayub Med Coll Abbottabad.2005; 17:54-6. thrice daily had 33.3% within group. In the other hand, no explained by the fact that anterior Cranial base is ed that LeFort- lll fracture was the strongest predic- 4. Mulligan RP, Friedman JA, Mababir BC. A nationwide remove biofilm on the tooth surface and decrease one with three times brushing daily reported severe dental people. About using dentifrices, out of 386 student’s expected level of awareness on oral health. Even relatively closer to midfacial structures and has more tor of severe head injury, followed by LeFort- ll and review of the associations among cervical spine injuries, 18. Davidoff G, Jakubowski M, et al. The spectrum of negative impact of it [ , ]. The most common proce- plaque index but 2.1% and 2% people reported with once majority of the students use tooth paste for tooth though this study was conducted among small sutural connection with midfacial bones compared to Zygomatico-maxillary fracture including Orbit this head injuries, and facial fractures. J Trauma. closed- head injuries in facial trauma victims:incidence and dure to removed dental biofilm involves using a tooth and twice brushing daily respectively. This relation was brushing 367(95.1%).On the other hand most of the sample group, it might provide important information the middle cranial base. Thus, the chance of anterior coincide with the other findings done by Kloss et al. 2010;68:587-92. impact. Ann Emerg Med.1998; 17:6-9. paste and tooth brush [ , ].The present concept of found statistically insignificant (p>0.05). students use tooth brush 377(97.7%) as tooth brush- to the citizen to take proper measures to maintain oral cranial base fracture and resulting CSF rhinorrhoea is reported that LeFort- lll fracture was the strongest tooth brushing involved around the beginning of the ing instruments. The study also showed that health for their children. As it is found significant expected to be higher. predictor of intracranial bleeding. 5. Gwyn PP, Carraway JH, Horton CE, Adamson JE, 19. Egol R, Fromm KR, et al. Guideline for intensive care nineteenth century. Prior to that time, wooden “chew Table no 4: Relationship between oral hygiene status 235(60.9%) clean their teeth once in a day. In order to relationship between oral hygiene status and dental Similar to other studies the most common neurologi- Mladick BA. Facial fractures-associated injuries and unit admission, discharge, and triage. Cr/f Care Med 1992; stick” or forms of tooth picks were used after meals of the respondents and dental plaque index prevent oral health problems, the American Dental plaque index, so at the end in the light of findings, we complications. Plast Reconstr Surg. 1971;47:225-30. 27:633-638. cal symptom was loss of consciousness, which can Conclusion have not changed from earlier times. Usually dental Association (ADA) recommends tooth brushing at may suggest that people should take effective meas- Regarding the frequency distribution of socio demographic [13] be manifestation of intracranial injury or concussion Adult males in the age group of 20-40 years were the biofilm can be prevented by mechanical and chemical least once a day .Regarding the distribution of ures to ensure good oral health of their children from 18,24 6. Kloss F, Laimer K, Hohlrieder M, Ulmer H, Hacki W, 20. Ahmad M, Rahman FN, Chowdhury MH, et al. Postmor- characteristics (Table-1) it was revealed that majority The pie chart (Figure-1) showed Dental Plaque Index of the head injury which was also more common in most common victims of craniofacial trauma. Road Benzer A, et al. Traumatic intracranial haemorrhage in tem study of head injury in fatal road: traffic accidents. way. For community level if we want to improve oral respondents, where 252(65.3%) had mild plaque, students by time of tooth brush most of them the very beginning. Children along with their parents 21,24 192(49.7%) of the respondents belongs to the age group of patients with fracture of the upper face moreover traffic accidents were responsible for the majority and conscious patients with facial fractures-a review of 1959 JAFMC.2009; 5 :(2):24-28. health, we have to ensure knowledge for prevention 6-11 years of which 244(63.21%). The most abundant study 126(32.6%)and 8(2.1%) had moderate plaque severe 213(55.2%) clean their mouth before breakfast. It should be given information and importance of tooth loss of consciousness is less common with isolated most of the patients sustained moderate head injuries cases. Craniomaxillofac Surg. 2008;36:372-7. within the community people as well as their practic- group was with primary education level and contributes to plaque respectively. was found that 274(71%) students use horizontal brushing to prevent plaque formation. Moreover, oral facial fractures. Gwynn et al found that life threaten- that were then managed conservatively. Fracture 21. Pradeep G, Ankit J, Nirmal K G. Association of Head es. To create positive health among the people, 237(61.4%) followed by junior education level 107 (27.7%). method during tooth brushing (Table-2).In another hygiene instruction should be highlighted through ing injuries such as cerebral concussion were mandible was the most common maxillofacial injury 7. Adeyemo WL, Ladeinde AL, Ogunlewe MO, James injury and Maxillofacial Trauma: A prospective Case- oro-dental health is to be given as serious thought Figure 2: Distribution of respondents according to study of Bangladesh found that 64.8% respondents planning, implementation, and evaluation of oral frequently associated with facial fractures26 which .More severe were the maxillofacial injury more were O.Trends and characteristics of oral and maxillofacial Control study. Indian journal of Applied Research. 2016; along with other factors necessary for promotion of Table 2: Distribution of respondents according to their Oral hygiene status (n=386) brushing should be done after meal and 60% use health promotion programs among school going support the result of our study. We found that 35% the chances of neurological injury. Fracture of the injuries in Nigeria: a review of the literature. Head Face 6(3): 528-531. health [ ]. It imposes a challenge of developing cultur- knowledge and practice of tooth brushing. (n=386) vertical scrub method for their tooth brushing[14].Al- children. Med. 2005; 1:7. patient had cerebral contusion. But at the same time, mid-face was found to be most commonly associated ally acceptable and sensitive program that has the though our findings regarding the time of brushing is 22.Malara P, Malara B et al:characteristics of maxillofacial as in present series, all patients who sustain moder- potential to provide knowledge and develop a health significantly differs from the previous study, it may be with head injury and the management of both neuro- 8. Van Hoof RF, Merkx CA, Stekelenburg SC. The different trauma resulting from road traffic accidents- a 5years References: ate or severe head injury also, had associated intrac- logical and maxillofacial injury was done according to patterns of fractures of the facial skeleton in four European review. Head and Face medicine. 2006:2:27. attitude in the population concerning oral health or by The association between the oral hygiene status of the the good indication that they develop the habit. This ranial injuries reflecting the severity and complexity of the necessity. countries. Int J Oral Surg.1977; 6 (1): 3-11. way of integrating scientific knowledge into traditional respondent and dental plaque index is presented in study found that regarding oral hygiene status majori- 1. Odell E, Cawson R and S. Porter. “Cawson'sessential of craniofacial trauma.18 23.Obuekwe ON, Ojo MA, Akpata O. Maxillofacial trauma oral health beliefs[ ]. The aim of the study was to Table-4. The result showed people with good and average ty of the respondents 232(60.1%) had average oral oral pathology and oral medicine”, 7thed. Churchikk Apart from maxillofacial fractures, high velocity Recommendations: 9. Brown RD. Cowpe JG. Patterns of maxillofacial trauma in due to road traffic accidents in Benin City, Nigeria: A assess the biofilm formation in oral cavity and its oral hygiene had no severe dental plaque index whereas hygiene condition (Figure-2). In another study on oral Livingstone, 1962: 38-39. impacts may result in ruptures of intracranial vessels, two different cultures: Acomparison:between Riyad and prospective study. Annals of African Medicine. 2003; 2(2): relationship with oral hygiene status related to tooth people with poor and very poor oral hygiene status suffered hygiene status of students in selected secondary In view of the high association of closed head injury in 2. Anna Frutiger.“Adsorption of Host and Bacterial leading to life-threatening intracranial hemorrhage, the facial fracture population, as well as high potenti- Tayside. JR Coil surg Edinb.1985; 30(5): 299-302. 58-63. brushing practice among school going children. from severe dental plaque index with value 6(11.5%) and school in Osogbo, Nigeria stated that 86.8% of the 2(66.7%) within group respectively. This result was statisti- Molecules to the Tooth Surface”: Dental Plaque Intracranial hemorrhage was found in 45% cases in ality for mortality and neurological morbidity the students had good oral hygiene, 12.1% have oral 10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture 24. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A as dental plaque [ ]. The first step in biofilm develop- cally significant (p<0.05). Biofilms(the student-edited microbiology resource). present study, which was more as compared to previ- authors of present study recommend the routine use Introduction: Materials and methods hygiene that could be said to be fair, while 1.2% had MicrobeWiki, 2010; 20:13 28 patterns: A suburban trauma center experience. An J review of 100 closed head injuriesassociated with facial [13] ous studies .This may be due to the difference in the of head CT for all patients sustaining a facial trauma Oral health care is one of the abandoned issues in ment is the adsorption of host and bacterial mole- This descriptive cross sectional study was carried out poor oral hygiene . The result of our study is very Otolaryngol. 2004; 25 (5): 301-307. fractures. J Oral Maxillofac Surg. 1992;50:218-22. Discussion: mode and severity of injuries. and close monitoring of neurological status of these our community. In the other hand oral hygiene main- cules on the tooth surface. Within minutes of tooth at police line school, Rajshahi during the period of negligible with respect to that study which reflects the 3. Marsh PD. Are Dental diseases examples of ecological This descriptive cross sectional study was carried out About intracranial lesions most of the victims had patients. tenance is the cheapest form of preventive health eruption or a cleaning, pellicle formation begins, May 2013 to December 2014. Sample was collected poor oral health of our society. Regarding dental catastrophes? Microbiology, 2003; 149(2): 279-94 11. Ansari MH. Maxillofacial fractures in Hamedan provi- 25. Chowdhury D. Depressed skull fractures: analysis of in police line school among 386 school going children subdural haemorrhage 18.3%, followed by extradural ence, Iran: A retrospective study (1987-2001). J Cranio- clinical outcome and cost effectiveness of timely surgical measure. Though cheap, it is surprisingly one of the which can be defined as a thin coat of salivary from 386 healthy students within the age range 6-16 plaque index, the study result revealed that most of most ignored practices especially in the underprivi- proteins [ ].The pellicle acts like an adhesive by stick- of 6-16 years of age group with the objective to 4. Martens L, Vanobbergen J, Leroy R, Lesaffre E, haemorrhage (15%), and subarachnoid haemor- Consent for the study maxilloac Surg.2004; 32 (I): 28-32. management. MS (Neurosurgery) thesis, BSMMU, 2002. years. Data were collected from the respondents by Figure 2 shows that according to simplified oral hygiene the respondents 65.3% had mild plaque (Figure-1). leged rural communities. School going children ing to the tooth surface and encourage a conditioning assess dental plaque and its relationship with oral Declerck D. Variable associated with oral hygiene levels in rhage (11.7%). In a study from India by Ashok KG et • All patients or relatives were given a necessary using semi structured interview administered ques- index [ ], majority 232(60.1%) of the respondents had To date the most dependable mode of plaque control 12. Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. 26. Gwynn P, Carraway JH, Horton CE, et al: Facial should have sufficient knowledge of understanding film of bacteria to attach to the pellicle. This condition- average oral hygiene status followed by 99(25.6%) with hygiene of the school going children in Rajshahi. The 7-year-olds in Belgium. Community Dent Health., al, showed that 5% victims had subdural haemor- explanation about the study before they asked to tionnaire and oral examination after taking verbal is mechanical cleaning with tooth brush. Many Characteristics of associated trauma in patients with head fractures-associated injuries and complications. Plast and the value of maintaining health practices, which in ing film directly influences the initial microbial coloni- good oral hygiene, 52(13.5%), 3(0.8%) poor and very poor study result revealed that out of 386 respondents, 2004;21(1):4-10 rhage 14% had subarachnoid haemorrhage and 13% participate. consent from the concerned authority as well as from surveys in different part of the world have found 14 injuries: An experience with 100 cases. J Trauma and Reconstr Surg. 1971; 47: 225-230. turn results bacterial accumulation in oral cavity and zation, and continues to adsorb bacteria on the tooth oral hygiene status respectively. majority of them 192(49.7%) belongs to the age [15] had extradural haemorrhage which is identical to • For those patients who were unconscious, consents the respondents. In this study simplified oral hygiene brushing to be the best way to maintain oral health . 5. Strydonck DAC etal. The anti-plaque efficacy in Shock. 2009; 2(2): 89-94. initially causes formation of a biofilm which is known surface. Initially the biofilm is soft enough to come off group of 6-11 years. The findings of this study is perti- our study. were obtained from their relatives. index [10] was followed to assess the overall oral Enwonwu in 2000, found that poor oral hygiene is one chlorohexidine mouthrinse used in combination with 27. Pappachan B,Alexander M. Correlating facial fractures Table no 3: Relationship between frequency of tooth nent with study conducted by U.S. census bureau [16] The results of previous studied evaluating the hygiene status depending on accumulation of food of the main cause of Noma . The study showed that toothbrushing with dentifrice. J clin Periodontol., • For patients under ages 18 years, informed 13. Adekeye SO. The pattern of fracture of facial skeleton in and Cranial Injuries. J Oral Maxillofacial Surg. 2006; brushing of the respondents and dental plaque index. showed that currently children aged 10-14 years was relationship between facial and head injuries are consents were obtained from their parents/ guardi- Kaduna Nigeria. A survey of 1447 cases. Oral Surg. 1980; 64:1023-1029. debris, calculus, gingiva alone with mucous mem- Almost all 364(94.3%) of the respondent learnt about tooth the frequency of the tooth brushing of the respondent 2004;31(8):691-5 conflicting. Hohlrieder et al reported that Le Fort- ll more than other age group in Bangladesh (2011 increased, the severity of dental plaque decreased, ans. 49(6): 491- 495. brane and periodontal condition and Dental plaque brushing and within this respondents majority 243(66.8%) [11] est.) . Out of 386, majority of them 244(63.21%) 6. Jain Y. A comparison of the efficacy of powered and and lll, Orbit, Nose,, Zygoma and Maxillary fractures 14. Ashok KG, Ran’ineesh G, Asish C. A retrospective 28. Zandi M, HoseiniSR. The relationship between head index was assessed According to Silness and Löe, of them learnt this from their family. It also showed that out but this relation was not statistically significant analysis of 189 patients of maxillofacial injuries presenting injury and facial trauma: a case- control study. J oral and were male and the ratio of male: female was 1.7:1. manual toothbrushes in controlling plaque and gingivitis. were associated with a 2-to 4 fold risk of intracranial References: (1964) [ ] where Score 1, Score 2 and Score 3 was of 386 students 367(95.1%) use tooth paste and (p>0.05) (Table-3).The study result also showed that hemorrhage, while mandibular fracture did not signifi- to a tertiary care hospital in Punjab, India. J Maxillofac Oral maxillofacial surgery. 2013; 7(3):201-207. 377(97.7%) use tooth brush for their tooth brushing. About Currently (2011 est.) under 15 year’s male-female oral hygiene status of the respondents had a strongly Clin Cosmet Investig Dent., 2013;5:3-9 1. Sharmin FN, Cameron P et al. Maxillofacial trauma in denoted as mild plaque, moderate plaque and severe [11] Burg. 2009; Sep;8(3):241-5. the frequency of the teeth brush 235(60.9%) of the ratio of our country is 1.01:1 .Regarding source of cantly increases the chance of intracranial hemor- major trauma patients. Aus Den Journ. 2006; plaque respectively. Finally data analysis was done significant association with dental plaque index 7. Zhang M, McGrath C, Hagg U. The impact of malocclu- 21 information of tooth brushing it was revealed that rhage . Haug et al. reported that although the mandi- 51(3):225-230. by using the SPSS software version 21.The results of respondents cleaned their teeth once daily and 213(55.2%) (p<0.05)(Table-4). 15. Haug RH, Foss J. Maxillofacial injuries in the pediatric sion and its treatment on quality of life: a literature review. ble was the most frequent fractured bone in patients cleaned their mouth before breakfast with this 274(71%) majority of them 243(66.8%) learned this from their patient. Oral Surg Oral Med Oral Pathol of Oral Radio the study have been presented in the following Int J Paediatr Dent, 2006;16(6):381-87 2. Follmar KE, Debruijn M, Baccarant A, Bruno AD, Muku- students use horizontal method of tooth brushing (Table-2). family. Another study done in 3 local government with concomitant facial and head injuries, midface Endod. 2000; 90:126-134. section by the tables, graph, charts and description. Conclusion: fractures were more frequently associated with ndan S, Erdmann D et al Concomitantinjuries in patients areas of Sokoto state of Nigeria shown that most of Most of the people of our country are not concerned 8. Lee KL, Schwarz, Mak Kyk. Improving Oral health

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through understanding the meaning of health and disease in Chinese culture. Int Dent J., 1993; 43:2-8.

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10. Greene JC, Vermillion JR. The oral hygiene index: a method for classifying oral hygiene status. JADA., 1960;61(2):172-179

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14. Ahmed MS, Al-Mamun MA, Begum S, Islam MS, Habib MA, Rahman MM. “Knowledge and Practice of tribal People in Rangpur Region Bangladesh”, International Journal of Dental Medicine, 2015; 1(3):28-32.

15. Mehrotra V, Gupta R, Sawhny A, Agarwal S, Gupta I, Garg K. Cultural, Religious, Social and Personal Customs “ A Boon or Bane” for Oral and General Health. Indian Jouirnal of Dental Education,2013;6(1): 21-32

16. Enwonwu CO, Falkler WA, Idigbe EO. “Oro-facialgang- rene (noma/cancrumoris):pathogenic mechanism”.Crit Rev Oral Biol Med, 2000; 11(2): 159-71 (RTC) were the most frequent cause of facial energy trauma causing maxillofacial injury are high the Oral and Maxillofacial surgery Department. Figure 1: Sex distribution of the patients (n=60) Table 3: Distribution of fracture facial bones (n=60) Table-5: Cross tabulation between pattern of facial 8.09:112. This indicates that males are more prone to beaten by her male partner and/or family members injuries7,8 However more recent studies have shown enough to cause concomitant head injury1,2,3,4. The fracture and severity of head injury (n-60) maxillofacial injury with or without head injury this for dowry for other reasons. We found only 1.7% in that assault is now the most common cause of maxil- purpose of this study was to evaluate the pattern of Statistical analysis high vulnerability of male gender for all type of trauma our study. lofacial injuries in developed countries9,10 where as head injuries in Patients with maxillofacial trauma and After the patient had given consent to be included in can be attributed to the fact that in our society males Isolated mandible fractures are most common facial traffic accidents remain the most frequent cause in to co relate the relationship between them. the study, a standardized structured data collection are predominantly the bread bearing for the family. bone to be fractured ranging from 12.9% to as high as many developing countries11 like Bangladesh. Others sheet was used to collect necessary information of Moreover they are at higher risk of injuries than 72.9%, followed by midface ranging from 25.9% to causes of maxillofacial trauma are fall from height, Material and methods: the study subject. The data were screened and women because of their greater exposure of automo- 29.5%11,12,21 the other frequently affected bones are assaults, altercation, pedestrian injury, home and This was a descriptive type of cross-sectional study checked for any missing value and discrepancy. The bile and motorcycle accident and engaged in more the floor of the orbit and nasal bones. However, in the industrial accidents and athletic injuries, in descend- carried out at the department of Oral & Maxillofacial data were then processed and analyzed using statis- risky behavior like hanging on the side of the bus or present series, the most frequent maxillofacial injury ing order of frequency12. Surgery, Bangabondhu Sheikh Mujib Medical Univer- tical software SPSS (statistical Package for Social rush to get in a running bus. represented was the fractured mandible 36.6%, The peak age of incidence of maxillofacial injuries sity, Shahbag, Dhaka. The period of study was from Science) version16. Chi- square test was carried out In our study, it was found that majority of patients followed by fractured Zygomatico-maxillary complex among 21 -30 years13 and more males are involved in 1st May 2010 to 30th April 2011. The patient’s data and significant level p value of < 0.05 was considered were in the age group between 2nd to 4th decade including orbit and Lefort fractures. In a survey by maxillofacial injuries than females14. Children are were collected from Inpatient department of Neuro- statistically significant. The summarized data were and mean age was 29.63 years which is similar to Malara P et ai in 2006, they found in 198 patients that Fig-1: Shows that among patients with both maxillofacial uniquely susceptible to maxillofacial injury because of surgery, Dhaka Medical College &Hospital and inpa- present in the form of tables, graphs and bar other studies of the globe.21 The possible explanation 18.69%suffered mandibular fracture, 12.63% Zygo- 15 and head injury 88.3% were male and 11.7% were female. their disproportionate cranial-body mass ratio . tient department of Oral and Maxillofacial Surgery, diagrams by the help of statistician. S = Significant for this is that the people in this age group take part in matic complex fracture and 12.2% maxillary 22 Patients older than 65 years account for approxi- Bangabondhu Sheikh Mujib Medical University, Table 2: Distribution of mode of injury (n=60) Table-3: Shows mandible was the most commonly Table-5: indicates that most of the zygomatic- maxillary dangerous exercise and sports, drive motor vehicles fractures . Obuekwe and Etetafia in 2004 found in mately 1% of maxillofacial trauma, and falls on a Shahbag, Dhaka who were referred from other Results and Observation: fractured facial bone (36.67%) (n=22) at different anatomi- complex fracture including orbit occurred in case of moder- carelessly and are more likely to be involved in their study, that mandible was the most common site slippery ground is the most common cause in this age Neurosurgical center. The total of 60 patients who cal locations. Both Zygomatico-maxillary complex fracture ate head injury and most of the Lefort-II fracture occurred in violence. Patients less than 10 years and more than of fracture, followed by Zygomatic complex and max- 16 23 group . sustained both cranial and facial injuries were includ- Table-1: Age distribution of the study subjects (n=60) and Lefort-II fracture were equal frequency 18.3% (n=11). patients with moderate and severe head injury. And most of 60 years were less frequently affected in our series. illa . The results of our study therefore correlate with It was evident that the facial bones fractures were ed in this study. After taking informed consent, data the Lefort-III fracture occurred in patient with severe head These could be explained that children are usually other literatures. uncommonly singular with compound and comminut- were collected by history, through clinical examina- Table-4: Distribution of involvement of cranium (n=60) injury. taken care of by elders during travelling and lesser In this study we found among LeFort fractures

ed nature adding on to the complexity of facial tion, radiographic evaluation and Neurosurgical mobility of geriatric people. But the effect of head LeFort- ll is more common (18.3%), than LeFort lll fractures. It is a common concept of fracture nasal Graph 3: Correlation between pattern of facial fracture injury is disproportionately severe in elderly and they (11.7%) and LeFort – l. The pattern is identical to consultation. Appropriate skull X-Rays were done in and severity of head injury bone being the most common facial bone to be all patients and patients with impaired conscious- require more neurosurgical care. studies conducted by Haug HR, Foss J. in 200015. fractured, then the zygoma followed by mandible and ness, neurological sign or clinical sign of basal skull The main causes of craniofacial injury worldwide are Our results demonstrated lower incidence of Nasal maxilla.17 fracture, an initial CT scan was also performed. assaults and road traffic accidents, but the preva- bone fracture (5%), although it is a common concept Apart from maxillofacial injury, high velocity impacts Information regarding age, gender, cause of injury, lence varies depending on the demographics and of fracture Nasal bone is the most frequent facial may result in fracture of facial bones and life threaten- pattern of facial and/or head injuries, loss of geography of the area. Road traffic accidents (RTA) bone to be fractured. It probably comes from the fact ing intracranial hemorrhages in different compart- consciousness, and GCS score were obtained and Table 2: indicates that majority of the victims suffered by are the commonest cause of craniofacial trauma in that isolated Nose fracture was managed by other ments requiring urgent neurosurgical intervention19. A recorded in questionnaires. motor vehicle accidents (60%), (n=36) followed by fall from most of the series5,11,12,20 and this occurred largely in specialties like ENT and Plastic Surgery. height (13.3%) (n=8) and pedestrians (11.7%), (n=7). decrease in the level of consciousness is the single The causes of injury were summarized as follows: our circumstance also (60%) because of reckless- GCS is a good marker for determining potential brain most reliable indicator that the patient has a serious ness and negligence of the drivers, poor mainte- injury, clinical conditions and prognosis of the patients Motor vehicle accidents, Fall from height, Pedestrian, Graph 2: Distribution of Glasgow Coma Score (GCS) head injury or secondary insult to the brain20. Loss of Assault, Sports injuries, Work-related injuries, and Mean ± SD = 29.63±12.0 Range = (5 - 64 years) nance of vehicles, often driving under the influence of following trauma24. On the basis of GCS scores of the intracranial hemorrhages, closed head traumas Majority of the victims were in the age group of 21 to of the patients (n=60) Introduction: consciousness is the manifestation of intracranial others. Table- 4: indicate that Linear fracture were more (31.6%) alcohol or drugs and complete disregard of traffic patients, It was found that, majority of patients with 40 years (75%), with 21-30 years (51.7%) more Maxillofacial trauma and concomitant head injuries (brain contusion or laceration), or fractures. General- injury or concussion head injury (62%), followed by Facial injuries included facial bone fractures and/or (n=19) then depressed fracture (n=16) and scalp injury. laws. Fall from height was the second most common head injury according to their GCS score were classi- ly, the presence of emesis, vomiting, loss of affected among this group. Children less than 10 yrs carry the significant potential for mortality and neuro- headache (33%), vomiting (27%), nasal bleed (30%) soft tissue injuries. Facial bone fractures were classi- Discussion: cause of injury in our series and attributed to 13.3%, fied as having moderate head injury 55% (n=33), consciousness, or a low Glasgow Coma Scale (GCS) 21 and elderly >60yrs of age made up a less frequency. logical morbidity. Maxillofacial trauma can occur as and oral bleed (10%) . fied as mandibular, Lefort I, Lefort II, Lefort III, Zygo- Figure-2: Distribution of type of head injury (n=60) Bangladesh is a south Asian developing country this occurred mostly in urban area where lot of followed by severe head injury 20% (n=12),mild head score are important findings for suspicion of a cranial an isolated injury or in combination with other severe The Glasgow Coma Scale score(GCS) is used to matico-maxillary fracture including orbit, and Nasal where poverty and unemployment forcing the people peoples worked as a day labour in construction of injury 15% (n=9), and minor head injury 10% (n=6) 1 injury. However, in patients with maxillofacial trauma, Graph 1: Age Distribution of the study subject (n=60) injuries . Patients with maxillofacial trauma may pres- quantify neurologic findings and it is widely accepted bone fractures. The types of mandibular fractures towards urban areas. This rapid and unplanned high rise buildings and painting them. It is in accord- respectively. The results from this study showed a head trauma may also be seen without observing the ent with associated intracranial, pulmonary, intra-ab- and a standardized method for evaluating level of were classified by anatomic site (condyle, ramus, urbanization associated with incompetent traffic ance with others findings from South India, which significantly higher incidence of moderate type of 2,3 suggestive findings6. dominal or extremity injuries . A close relationship consciousness depending on the score of the GCS angle, body, symphysis, parasymphyses and coro- system, unplanned roads and highways, violation of reported 16,6% of Craniofacial trauma were due to head injuries associated with maxillofacial injuries as The etiology of maxillofacial injuries varies from one 12 between maxillofacial fracture and intracranial injury head injury can be classified as very mild, mild, mod- noid). traffic laws by the drivers and pedestrian injury, over- fall from coconut tree. In our study, we found, compared to other reports in the English literature. 4-6 country to another and even within the same depend- has been reported in many articles . In many coun- erate and severe head injury. About intracranial Head injuries included skull fractures and/or intracra- crowding, etc are responsible for highest figure of pedestrians constituted 11.7% of the total victims. In In case of head injury, various pattern of skull fracture ing on the prevailing socioeconomic, cultural and tries, cranial injury has been found to be the most lesions, contusion/ concussion, extradural hemato- nial injuries. Skull fractures were classified into scalp road traffic accidents, and these RTA victims are Dhaka city, a large number of pedestrians are were found. Linear fracture was the commonest type environmental factors. Earlier studies from Europe common accompanying organ injury in patients with ma, subdural hematoma, subarachnoid hematoma injury, linear fracture and depressed fracture of mainly suffered from Craniofacial injury. garments employees and day labor. They have lack (31.6%) followed by depressed fracture (26.6%). 3,4 and America revealed that Road Traffic crashes maxillofacial trauma . These includes head traumas, and intracerebral haematoma occurs most frequent- frontal, temporal, parietal, occipital, and basal skull Above figure indicates that most of the study population In the present study, majority of the head and of knowledge regarding traffic rules, shortage of Linear fracture was the commonest one because 20 ly . fractures. Intracranial injuries were summarized as suffered from moderate head injury (55%), (n=33), followed concomitant facial injuries were experienced by space in footpath, most of which are occupied by the during RTA head strikes by forcible contact with broad Existing literature on the correlation of traumatic head concussion, cerebral contusion, and intracranial by severe head injury (20%) (n=12), mild head injury (15%), hawkers. Most of the pedestrians are not used to use resting surface like roads18. This result was identical (n=9) and very mild head injury (10%) (n=6). males, constituted 88.3% and females constituted injuries and maxillofacial trauma Is highly controver- hemorrhage (epidural, subdural, intracerebral and the pedestrian’s bridge. That’s why pedertrain injury to other study done by Ahmed et al in 2009 in Bang- Above figure indicates that, most of the study population only 11.7% of the total victims. The male to female sial. Some suggest that it is the facial skeleton that is a common cause of injury in our country. Domestic ladesh.20 Regarding depressed fracture of individual subarachnoid). Above graph indicates that 21-30 years age group was suffered from contussion (35%) (n=21). 18.3% had ratio was 7.57:1. These results are similar in a study absorbs the energy of the trauma, protecting the Brain trauma was handled by Neurosurgery depart- more commonly affected. subdural hemorrhage (n=11) and 15% had Extradural from India, where 89% of subjects were males and violence is another cause of craniofacial trauma in bones, Frontal was most prone to fracture (16.66%) brain from injury, whereas, others suggest that high ment and complex facial fractures were repaired by haemorrhage (n=9). 11% were females, giving a male to female ratio our country, where the women are most of the time followed by fracture temporal bone (5%) and parietal

Update Dental College Journal Vol. 7 No. 1 | April 2017 bone. This coincides with other study done previously closed head injuries than mandible fracture.19 These with panfacial fractures. J Trauma. 2007; 63:831-5. 16. Rehman K, Edmcndson H. The causes and conse- by using the fingernail. However, it starts to harden Results: Figure 1: Distribution of respondents according to χ2 =1.668, dƒ=4; p>0.05 the mothers (57%) did not know that the children about their oral health due to their lack of knowledge. at BSMMU in Bangladesh in 2002.25 difference in the facial bone or head injury being stud- quences of maxillofacial injuries in elderly people. Gero- within 48 hours, and in about 10 days the biofilm Table 1: Distribution of respondents according to Dental Plaque index. (n=386) Table-3 showed the relationship between frequency of the have to be assisted in cleaning their teeth till they As a consequence, they suffer from diverse of oral In agreement with a study by Pappachan and Alexan- ied and the variation in classification, nomenclature 3. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associ- dontology. 2002; 19:60-64. becomes hard and difficult to remove. This tarter socio demographic characteristics. (n=386) tooth brushing of the students and the dental plaque index. attained the age of seven [12]. In this case the effort of problems. Although some people have the practice of der, we observed that CSF rhinorrhoea was nearly or methodology of prior studies may explain these ated injuries in facial fractures: review of839 patients. Br J happens when biofilm is not removed by regular It was found that respondents brushed once daily had our mother towards children oral health is higher that tooth brushing but they apply wrong technique results Plast Surg. 1993;46:635-8. 17. Khan AR, Arif S. Ear nose and throat injuries in children. 66.0% mild dental plaque index whereas who brushed twice as frequent as CSF otorrhoea.27 This may be conflicting result. In the present study we demonstrat- brushing or flossing. Tooth brushing is the only way to prevails the higher consciousness of the Bangladeshi different kind of oral diseases and not reached the J Ayub Med Coll Abbottabad.2005; 17:54-6. thrice daily had 33.3% within group. In the other hand, no explained by the fact that anterior Cranial base is ed that LeFort- lll fracture was the strongest predic- 4. Mulligan RP, Friedman JA, Mababir BC. A nationwide remove biofilm on the tooth surface and decrease one with three times brushing daily reported severe dental people. About using dentifrices, out of 386 student’s expected level of awareness on oral health. Even relatively closer to midfacial structures and has more tor of severe head injury, followed by LeFort- ll and review of the associations among cervical spine injuries, 18. Davidoff G, Jakubowski M, et al. The spectrum of negative impact of it [ , ]. The most common proce- plaque index but 2.1% and 2% people reported with once majority of the students use tooth paste for tooth though this study was conducted among small sutural connection with midfacial bones compared to Zygomatico-maxillary fracture including Orbit this head injuries, and facial fractures. J Trauma. closed- head injuries in facial trauma victims:incidence and dure to removed dental biofilm involves using a tooth and twice brushing daily respectively. This relation was brushing 367(95.1%).On the other hand most of the sample group, it might provide important information the middle cranial base. Thus, the chance of anterior coincide with the other findings done by Kloss et al. 2010;68:587-92. impact. Ann Emerg Med.1998; 17:6-9. paste and tooth brush [ , ].The present concept of found statistically insignificant (p>0.05). students use tooth brush 377(97.7%) as tooth brush- to the citizen to take proper measures to maintain oral cranial base fracture and resulting CSF rhinorrhoea is reported that LeFort- lll fracture was the strongest tooth brushing involved around the beginning of the ing instruments. The study also showed that health for their children. As it is found significant expected to be higher. predictor of intracranial bleeding. 5. Gwyn PP, Carraway JH, Horton CE, Adamson JE, 19. Egol R, Fromm KR, et al. Guideline for intensive care nineteenth century. Prior to that time, wooden “chew Table no 4: Relationship between oral hygiene status 235(60.9%) clean their teeth once in a day. In order to relationship between oral hygiene status and dental Similar to other studies the most common neurologi- Mladick BA. Facial fractures-associated injuries and unit admission, discharge, and triage. Cr/f Care Med 1992; stick” or forms of tooth picks were used after meals of the respondents and dental plaque index prevent oral health problems, the American Dental plaque index, so at the end in the light of findings, we complications. Plast Reconstr Surg. 1971;47:225-30. 27:633-638. cal symptom was loss of consciousness, which can Conclusion have not changed from earlier times. Usually dental Association (ADA) recommends tooth brushing at may suggest that people should take effective meas- Regarding the frequency distribution of socio demographic [13] be manifestation of intracranial injury or concussion Adult males in the age group of 20-40 years were the biofilm can be prevented by mechanical and chemical least once a day .Regarding the distribution of ures to ensure good oral health of their children from 18,24 6. Kloss F, Laimer K, Hohlrieder M, Ulmer H, Hacki W, 20. Ahmad M, Rahman FN, Chowdhury MH, et al. Postmor- characteristics (Table-1) it was revealed that majority The pie chart (Figure-1) showed Dental Plaque Index of the head injury which was also more common in most common victims of craniofacial trauma. Road Benzer A, et al. Traumatic intracranial haemorrhage in tem study of head injury in fatal road: traffic accidents. way. For community level if we want to improve oral respondents, where 252(65.3%) had mild plaque, students by time of tooth brush most of them the very beginning. Children along with their parents 21,24 192(49.7%) of the respondents belongs to the age group of patients with fracture of the upper face moreover traffic accidents were responsible for the majority and conscious patients with facial fractures-a review of 1959 JAFMC.2009; 5 :(2):24-28. health, we have to ensure knowledge for prevention 6-11 years of which 244(63.21%). The most abundant study 126(32.6%)and 8(2.1%) had moderate plaque severe 213(55.2%) clean their mouth before breakfast. It should be given information and importance of tooth loss of consciousness is less common with isolated most of the patients sustained moderate head injuries cases. Craniomaxillofac Surg. 2008;36:372-7. within the community people as well as their practic- group was with primary education level and contributes to plaque respectively. was found that 274(71%) students use horizontal brushing to prevent plaque formation. Moreover, oral facial fractures. Gwynn et al found that life threaten- that were then managed conservatively. Fracture 21. Pradeep G, Ankit J, Nirmal K G. Association of Head es. To create positive health among the people, 237(61.4%) followed by junior education level 107 (27.7%). method during tooth brushing (Table-2).In another hygiene instruction should be highlighted through ing injuries such as cerebral concussion were mandible was the most common maxillofacial injury 7. Adeyemo WL, Ladeinde AL, Ogunlewe MO, James injury and Maxillofacial Trauma: A prospective Case- oro-dental health is to be given as serious thought Figure 2: Distribution of respondents according to study of Bangladesh found that 64.8% respondents planning, implementation, and evaluation of oral frequently associated with facial fractures26 which .More severe were the maxillofacial injury more were O.Trends and characteristics of oral and maxillofacial Control study. Indian journal of Applied Research. 2016; along with other factors necessary for promotion of Table 2: Distribution of respondents according to their Oral hygiene status (n=386) brushing should be done after meal and 60% use health promotion programs among school going support the result of our study. We found that 35% the chances of neurological injury. Fracture of the injuries in Nigeria: a review of the literature. Head Face 6(3): 528-531. health [ ]. It imposes a challenge of developing cultur- knowledge and practice of tooth brushing. (n=386) vertical scrub method for their tooth brushing[14].Al- children. Med. 2005; 1:7. patient had cerebral contusion. But at the same time, mid-face was found to be most commonly associated ally acceptable and sensitive program that has the though our findings regarding the time of brushing is 22.Malara P, Malara B et al:characteristics of maxillofacial as in present series, all patients who sustain moder- potential to provide knowledge and develop a health significantly differs from the previous study, it may be with head injury and the management of both neuro- 8. Van Hoof RF, Merkx CA, Stekelenburg SC. The different trauma resulting from road traffic accidents- a 5years References: ate or severe head injury also, had associated intrac- logical and maxillofacial injury was done according to patterns of fractures of the facial skeleton in four European review. Head and Face medicine. 2006:2:27. attitude in the population concerning oral health or by The association between the oral hygiene status of the the good indication that they develop the habit. This ranial injuries reflecting the severity and complexity of the necessity. countries. Int J Oral Surg.1977; 6 (1): 3-11. way of integrating scientific knowledge into traditional respondent and dental plaque index is presented in study found that regarding oral hygiene status majori- 1. Odell E, Cawson R and S. Porter. “Cawson'sessential of craniofacial trauma.18 23.Obuekwe ON, Ojo MA, Akpata O. Maxillofacial trauma oral health beliefs[ ]. The aim of the study was to Table-4. The result showed people with good and average ty of the respondents 232(60.1%) had average oral oral pathology and oral medicine”, 7thed. Churchikk Apart from maxillofacial fractures, high velocity Recommendations: 9. Brown RD. Cowpe JG. Patterns of maxillofacial trauma in due to road traffic accidents in Benin City, Nigeria: A assess the biofilm formation in oral cavity and its oral hygiene had no severe dental plaque index whereas hygiene condition (Figure-2). In another study on oral Livingstone, 1962: 38-39. impacts may result in ruptures of intracranial vessels, two different cultures: Acomparison:between Riyad and prospective study. Annals of African Medicine. 2003; 2(2): relationship with oral hygiene status related to tooth people with poor and very poor oral hygiene status suffered hygiene status of students in selected secondary In view of the high association of closed head injury in 2. Anna Frutiger.“Adsorption of Host and Bacterial leading to life-threatening intracranial hemorrhage, the facial fracture population, as well as high potenti- Tayside. JR Coil surg Edinb.1985; 30(5): 299-302. 58-63. brushing practice among school going children. from severe dental plaque index with value 6(11.5%) and school in Osogbo, Nigeria stated that 86.8% of the 2(66.7%) within group respectively. This result was statisti- Molecules to the Tooth Surface”: Dental Plaque Intracranial hemorrhage was found in 45% cases in ality for mortality and neurological morbidity the students had good oral hygiene, 12.1% have oral 10. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture 24. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A as dental plaque [ ]. The first step in biofilm develop- cally significant (p<0.05). Biofilms(the student-edited microbiology resource). present study, which was more as compared to previ- authors of present study recommend the routine use Introduction: Materials and methods hygiene that could be said to be fair, while 1.2% had MicrobeWiki, 2010; 20:13 28 patterns: A suburban trauma center experience. An J review of 100 closed head injuriesassociated with facial [13] ous studies .This may be due to the difference in the of head CT for all patients sustaining a facial trauma Oral health care is one of the abandoned issues in ment is the adsorption of host and bacterial mole- This descriptive cross sectional study was carried out poor oral hygiene . The result of our study is very Otolaryngol. 2004; 25 (5): 301-307. fractures. J Oral Maxillofac Surg. 1992;50:218-22. Discussion: mode and severity of injuries. and close monitoring of neurological status of these our community. In the other hand oral hygiene main- cules on the tooth surface. Within minutes of tooth at police line school, Rajshahi during the period of negligible with respect to that study which reflects the 3. Marsh PD. Are Dental diseases examples of ecological This descriptive cross sectional study was carried out About intracranial lesions most of the victims had patients. tenance is the cheapest form of preventive health eruption or a cleaning, pellicle formation begins, May 2013 to December 2014. Sample was collected poor oral health of our society. Regarding dental catastrophes? Microbiology, 2003; 149(2): 279-94 11. Ansari MH. Maxillofacial fractures in Hamedan provi- 25. Chowdhury D. Depressed skull fractures: analysis of in police line school among 386 school going children subdural haemorrhage 18.3%, followed by extradural ence, Iran: A retrospective study (1987-2001). J Cranio- clinical outcome and cost effectiveness of timely surgical measure. Though cheap, it is surprisingly one of the which can be defined as a thin coat of salivary from 386 healthy students within the age range 6-16 plaque index, the study result revealed that most of most ignored practices especially in the underprivi- proteins [ ].The pellicle acts like an adhesive by stick- of 6-16 years of age group with the objective to 4. Martens L, Vanobbergen J, Leroy R, Lesaffre E, haemorrhage (15%), and subarachnoid haemor- Consent for the study maxilloac Surg.2004; 32 (I): 28-32. management. MS (Neurosurgery) thesis, BSMMU, 2002. years. Data were collected from the respondents by Figure 2 shows that according to simplified oral hygiene the respondents 65.3% had mild plaque (Figure-1). leged rural communities. School going children ing to the tooth surface and encourage a conditioning assess dental plaque and its relationship with oral Declerck D. Variable associated with oral hygiene levels in rhage (11.7%). In a study from India by Ashok KG et • All patients or relatives were given a necessary using semi structured interview administered ques- index [ ], majority 232(60.1%) of the respondents had To date the most dependable mode of plaque control 12. Rajendra PB, Mathew TP, Agrawal A, Sabharawal G. 26. Gwynn P, Carraway JH, Horton CE, et al: Facial should have sufficient knowledge of understanding film of bacteria to attach to the pellicle. This condition- average oral hygiene status followed by 99(25.6%) with hygiene of the school going children in Rajshahi. The 7-year-olds in Belgium. Community Dent Health., al, showed that 5% victims had subdural haemor- explanation about the study before they asked to tionnaire and oral examination after taking verbal is mechanical cleaning with tooth brush. Many Characteristics of associated trauma in patients with head fractures-associated injuries and complications. Plast and the value of maintaining health practices, which in ing film directly influences the initial microbial coloni- good oral hygiene, 52(13.5%), 3(0.8%) poor and very poor study result revealed that out of 386 respondents, 2004;21(1):4-10 rhage 14% had subarachnoid haemorrhage and 13% participate. consent from the concerned authority as well as from surveys in different part of the world have found 14 injuries: An experience with 100 cases. J Trauma and Reconstr Surg. 1971; 47: 225-230. turn results bacterial accumulation in oral cavity and zation, and continues to adsorb bacteria on the tooth oral hygiene status respectively. majority of them 192(49.7%) belongs to the age [15] had extradural haemorrhage which is identical to • For those patients who were unconscious, consents the respondents. In this study simplified oral hygiene brushing to be the best way to maintain oral health . 5. Strydonck DAC etal. The anti-plaque efficacy in Shock. 2009; 2(2): 89-94. initially causes formation of a biofilm which is known surface. Initially the biofilm is soft enough to come off group of 6-11 years. The findings of this study is perti- our study. were obtained from their relatives. index [10] was followed to assess the overall oral Enwonwu in 2000, found that poor oral hygiene is one chlorohexidine mouthrinse used in combination with 27. Pappachan B,Alexander M. Correlating facial fractures Table no 3: Relationship between frequency of tooth nent with study conducted by U.S. census bureau [16] The results of previous studied evaluating the hygiene status depending on accumulation of food of the main cause of Noma . The study showed that toothbrushing with dentifrice. J clin Periodontol., • For patients under ages 18 years, informed 13. Adekeye SO. The pattern of fracture of facial skeleton in and Cranial Injuries. J Oral Maxillofacial Surg. 2006; brushing of the respondents and dental plaque index. showed that currently children aged 10-14 years was relationship between facial and head injuries are consents were obtained from their parents/ guardi- Kaduna Nigeria. A survey of 1447 cases. Oral Surg. 1980; 64:1023-1029. debris, calculus, gingiva alone with mucous mem- Almost all 364(94.3%) of the respondent learnt about tooth the frequency of the tooth brushing of the respondent 2004;31(8):691-5 conflicting. Hohlrieder et al reported that Le Fort- ll more than other age group in Bangladesh (2011 increased, the severity of dental plaque decreased, ans. 49(6): 491- 495. brane and periodontal condition and Dental plaque brushing and within this respondents majority 243(66.8%) [11] est.) . Out of 386, majority of them 244(63.21%) 6. Jain Y. A comparison of the efficacy of powered and and lll, Orbit, Nose,, Zygoma and Maxillary fractures 14. Ashok KG, Ran’ineesh G, Asish C. A retrospective 28. Zandi M, HoseiniSR. The relationship between head index was assessed According to Silness and Löe, of them learnt this from their family. It also showed that out but this relation was not statistically significant analysis of 189 patients of maxillofacial injuries presenting injury and facial trauma: a case- control study. J oral and were male and the ratio of male: female was 1.7:1. manual toothbrushes in controlling plaque and gingivitis. were associated with a 2-to 4 fold risk of intracranial References: (1964) [ ] where Score 1, Score 2 and Score 3 was of 386 students 367(95.1%) use tooth paste and (p>0.05) (Table-3).The study result also showed that hemorrhage, while mandibular fracture did not signifi- to a tertiary care hospital in Punjab, India. J Maxillofac Oral maxillofacial surgery. 2013; 7(3):201-207. 377(97.7%) use tooth brush for their tooth brushing. About Currently (2011 est.) under 15 year’s male-female oral hygiene status of the respondents had a strongly Clin Cosmet Investig Dent., 2013;5:3-9 1. Sharmin FN, Cameron P et al. Maxillofacial trauma in denoted as mild plaque, moderate plaque and severe [11] Burg. 2009; Sep;8(3):241-5. the frequency of the teeth brush 235(60.9%) of the ratio of our country is 1.01:1 .Regarding source of cantly increases the chance of intracranial hemor- major trauma patients. Aus Den Journ. 2006; plaque respectively. Finally data analysis was done significant association with dental plaque index 7. Zhang M, McGrath C, Hagg U. The impact of malocclu- 21 information of tooth brushing it was revealed that rhage . Haug et al. reported that although the mandi- 51(3):225-230. by using the SPSS software version 21.The results of respondents cleaned their teeth once daily and 213(55.2%) (p<0.05)(Table-4). 15. Haug RH, Foss J. Maxillofacial injuries in the pediatric sion and its treatment on quality of life: a literature review. ble was the most frequent fractured bone in patients cleaned their mouth before breakfast with this 274(71%) majority of them 243(66.8%) learned this from their patient. Oral Surg Oral Med Oral Pathol of Oral Radio the study have been presented in the following Int J Paediatr Dent, 2006;16(6):381-87 2. Follmar KE, Debruijn M, Baccarant A, Bruno AD, Muku- students use horizontal method of tooth brushing (Table-2). family. Another study done in 3 local government with concomitant facial and head injuries, midface Endod. 2000; 90:126-134. section by the tables, graph, charts and description. Conclusion: fractures were more frequently associated with ndan S, Erdmann D et al Concomitantinjuries in patients areas of Sokoto state of Nigeria shown that most of Most of the people of our country are not concerned 8. Lee KL, Schwarz, Mak Kyk. Improving Oral health

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