Falls, sports injuries interpersonal violence and road traffic accidents are reported to be the main causes of maxillofacial fractures in children and adolescents. A review in 2017 (Barbosa et al) reported road traffic accidents to be the main cause of maxillofacial fractures in children and adolescents.
The aim of this review was to assess the prevalence of maxillofacial trauma by different causes in children and adolescents.
Methods
Searches were conducted in the Cochrane Library, PubMed/Medline, Scopus and the Web of Science with no language restrictions. Cross-sectional and pro- and retrospective cohort studies reporting the prevalence of maxillofacial trauma based on aetiology with a diagnosis based on clinical records in children/adolescents aged 0 to 19 years of age including 30 or more cases were considered. Two reviewers independently selected studies and extracted data with quality being assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Maxillo- facial trauma was classified as road traffic accidents (RTAs), violence (assaults, fights, use of weapons, and/or firearms) , falls, sports, and other aetiologies (animal bites, domestic accident, play, abuse etc).The prevalence of maxillofacial trauma was analysed by calculation of the event rates and 95% confidence intervals (CIs).
Results
- 58 studies were included.
- The number of cases in the studies ranged between 37 to 183,336.
- The commonest cause of maxillofacial trauma overall were road traffic accidents followed by falls (see table below).
| Aetiology | Event rate (95%CI) |
| Road traffic accidents | 33.8% (28.3% to 39.9%) |
| Falls | 20.7% (18.4% to 23.3%) |
| Violence | 9.9% (7.8% to 12.4%) |
| Sports | 8.1% (6.3% to 10.3%) |
| Other | 9.7% (7.8% to 12.0%) |
- The event rates for the main trauma aetiologies by region are shown in the tables below.
Road traffic Accidents
| No of studies | Event rate (95%CI) | |
| African | 6 | 48.3% (34.8% to 62.1%) |
| Asian | 28 | 29.9% (23.1% to 37.8%) |
| European | 5 | 24.8% (8.7% to 53.1%) |
| North American | 9 | 34.1% (19.7% to 52.2%) |
| South American | 9 | 29.8% (14.0% to 52.5%) |
| Overall | 58 | 33.8% (28.3% to 39.9%) |
Falls
| No of studies | Event rate (95%CI) | |
| African | 5 | 32.1% (19.3% to 48.4%) |
| Asian | 29 | 44.1% (37.0% to 51.5%) |
| European | 5 | 33.9% (20.6% to 50.4%) |
| North American | 9 | 11.1% (9.3% to 13.2%) |
| South American | 9 | 34% (27.7% to 44.7%) |
| Overall | 58 | 20.7% (18.4% to 23.3%) |
Violence
| No of studies | Event rate (95%CI) | |
| African | 6 | 11.1% (6.8% to 17.5%) |
| Asian | 26 | 5.3% (3.2% to 8.7%) |
| European | 5 | 7.9% (4.5% to 13.6%) |
| North American | 9 | 27.6% (14.8% to 45.5%) |
| South American | 9 | 11.2% (7.0% to 17.4%) |
| Overall | 55 | 9.9% (7.8% to 12.4%) |
Sports
| No of studies | Event rate (95%CI) | |
| African | 3 | 8.0% (2.8% to 20.7%) |
| Asian | 20 | 8.5% (6.1% to 11.6%) |
| European | 5 | 9.0% (4.8% to 16.4%) |
| North American | 4 | 13.3% (6.2% to 26.1%) |
| South American | 9 | 3.9% (1.9% to 7.8%) |
| Overall | 55 | 8.1% (6.3% to 10.3%) |
Other aetiologies
| No of studies | Event rate (95%CI) | |
| African | 6 | 4.5% (1.4% to 13.2%) |
| Asian | 29 | 7.9% (5.6% to 11.0%) |
| European | 5 | 13.3% (7.1% to 23.7%) |
| North American | 9 | 12.2% (8.3% to 17.7%) |
| South American | 9 | 10.8% (5.6% to 19.8%) |
| Overall | 55 | 9.7% (7.8% to 12.0%) |
Conclusions
The authors concluded: –
Road traffic accidents were the most prevalent aetiology of maxillofacial trauma in the world, followed by falls, violence, and sports among children and adolescents.
Comments
No protocol for the review was registered or published. A good range of databases was searched with no language restriction. The authors report assessing study quality using the Newcastle-Ottawa Scale and indicate that the included studies were methodologically similar although they do not present more detailed information in the main paper. The 2017 review by Barbosa included 27 studies compared with the 58 studies in this new review. A majority of the studies come from Asia with few studies from Europe and Africa and it is interesting to note that an earlier multi-country review (Dental Elf – 5th Jan 2015) reported that assaults and falls were the main cause of maxillofacial trauma, although this study involved broader age-groups. Variation across the age groups in the available studies was one of the issues contributing to the heterogeneity in the studies included and a move to agreeing standardised age groups would be helpful for future. There is also some concern around categorisation of the main aetiologies in studies and the use of the ‘other causes’ classification.
Links
Primary Paper
Mohammadi H, Roochi MM, Heidar H, Garajei A, Dallband M, Sadeghi M, Fatahian R, Tadakamadla SK. A meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies among children and adolescents. Dent Traumatol. 2023 Oct;39(5):403-417. doi: 10.1111/edt.12845. Epub 2023 Apr 19. PMID: 37073864.
Other references
Barbosa KGN, de Macedo Bernardino Í, d’Avila S, Ferreira EFE, Ferreira RC. Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents. Oral Maxillofac Surg. 2017 Jun;21(2):131-145. doi: 10.1007/s10006-017-0610-9. Epub 2017 Mar 9. PMID: 28280940.
Dental Elf – 5th Jan 2015
Maxillofacial trauma: assaults and falls the main causes in Europe
Dental Elf 3rd May 2021
Dental Elf – 19th Apr 2021
Dental Elf – 26th Jun 2023
Helmet use and maxillofacial injuries due to bicycle and scooter accidents
Picture Credits
Photo by Clark Van Der Beken on Unsplash
