Characteristics of Maxilofacial Fractures That Entered the ER at Dr. Mohammad Hoesin General Hospital Palembang Period 1 January 2019 - 31 December 2019

Background: Maxillofacial trauma is a wound or injury that affects the face and jaw. 1 Trauma to the hard tissues of the face can cause maxillofacial fractures, which is damage or breaking of the continuity of the facial bones. Traffic accidents remain the main cause of maxillofacial injury, followed by violence, sports, work-related injuries, and falls 9,10,11,12 The high number of traffic accidents and violence in Palembang city can increase the risk of maxillofacial fracture. The absence of data regarding the characteristics of patients with maxillofacial fractures at Dr. Mohammad Hoesin General Hospital Palembang became the reason for this research. Methods: This research is a descriptive observational study with a cross sectional design using secondary data through patient medical records for the period January 2019- December 2019. Results: There were 89 patients with maxillofacial fractures with complete medical record data. There were more men (83.14%) than women (16.85%). The youngest age of the patient was 7 years, while the oldest age was 70 years, with the mean age of the patient was 29 years. Traffic accidents were the most common cause (79.7%) followed by falls (11.2 %), violence (4.4 %), sports accidents (1.1 %), and other causes (3.3%). 28 fracture locations were recorded on the upper with fracture locations on the lower face. The zygomaticomaxillaris complex fracture was the most common fractured bone (35.9%). Regarding management, most were managed with ORIF (66.2%) followed by elevated craniotomy (16.85%), conservative (12.35%), soft tissue debridement repair (2.2%) and closed reduction and nasal repositioning (2.2%). Conclusion: Maxillofacial fracture are found commonly in men. Most patient age ranges. is the age of 21-30 years. The most common cause is traffic accidents. The most frequently affected fracture site is the midface, where the most commonly affected bone is the zygomaticomaxillaris complex. The treatment option most often applied is ORIF.


Introduction
Maxillofacial trauma is a wound or injury that affects the face and jaw.1 Trauma to the hard tissues of the face can cause maxillofacial fractures, which is damage or breaking of the continuity of the facial bones. Maxillofacial fracture is divided into three fracture regions based on anatomy including, lower third fracture of the face, middle third fracture of the face, and fracture of the upper third of the face. [2][3] The face is very susceptible to injury due to trauma, 20-60% of all traffic accidents cause fractures of the facial bones. 4,5 Traffic accidents remain the main cause of maxillofacial injury, followed by violence, sports, work-related injuries, and falls 9,10,11,12 The majority of maxillofacial fractures occur in men between the ages of 21 and 30 years, with a male-to-female ratio ranging from 2: 1 to 11: 1 9,12,13. The mandible is the bone most commonly fractured in several studies.

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The high number of traffic accidents and violence in Palembang city can increase the risk of maxillofacial fracture. RSUP Dr. Mohammad Hoesin, as a class A public hospital in Palembang City as a referral center for health services in West Sumatra, is possible to become one of the referral centers for maxillofacial fracture cases. The absence of data regarding the characteristics of patients with maxillofacial fractures at RSUP Dr. Mohammad Hoesin Palembang for the period of January-December 2019 became the reason for this research.

Method
This research is a descriptive observational study with a cross sectional design using secondary data through patient medical records for the period January 2019-December 2019. The research sample was maxillofacial fracture patients who entered through the Emergency Room of Mohammad Hoesin Hospital Palembang during January 2019 s.d. December 2019. Exclusion criteria were medical record data of patients with maxillofacial fractures which did not contain one or more of the criteria to be investigated including etiology, sex, age, and anatomical location. This study used a purposive sampling technique.
Variables researched were age, gender, etiology, location of fracture, and treatment. The data analysis technique used is descriptive analysis, namely by presenting the data numerically and graphically in the form of a diagram of the prevalence of maxillofacial fractures

Results
There were 89 cases of maxillofacial fracture who were treated at the ER RSUP Dr. Mohammad Hoesin Palembang for the period of January 1, 2019 to December 31, 2019 who went to the subdivision of plastic surgery with complete data. The gender distribution of research subjects can be seen in diagram 1.
There were 74 men with maxillofacial fractures and 15 women.
From the distribution based on age, there were 0 patients in the age group 0-2 years and 3-5 years, 3 patients in the age group 6-11 years, 34 patients in the age group 12-21 years, 28 patients in the age group 22-39 years, 21 patients in the 40-59 years age group, and 3 patients in the > 60 years age group. The youngest age of the patient was 7 years, while the oldest age was 70 years, with the mean age of the patient was 29 years.

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From the distribution based on etiology there were 71 maxillofacial fractures caused by traffic accidents, 4 maxillofacial fractures due to violence, 1 maxillofacial fracture due to sports accidents, 10 maxillofacial fractures due to falls, 3 maxillofacial fractures due to other causes.  Regarding the distribution of fracture location, 28 fracture locations were recorded on the upper face, 55 with fracture locations at the midface, 26 with fracture locations on the lower face. The zygomaticomaxillaris complex fracture was the most common fractured bone in this study followed by the maxilla and frontal and mandibular bones.

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Regarding the distribution of treatment, 11 people were managed conservatively, 2 people were treated with debridement and soft tissue repair, 59 people were treated with ORIF, 2 people were treated with closed reduction and nasal repositioning, 15 people were treated with elevation craniotomy.

Discussion
Our study revealed that there were more men (83.14%) than women (16.85% The largest distribution of etiology of maxillofacial fracture was traffic accident (79.7%) followed by falls (11.2 %) ), violence ( Our study revealed that the largest distribution of fractured location was on the midface (61.7% showed that closed reduction was the most common treatment for maxillofacial fractures. 42 This result was due to differences in the distribution of variations in the anatomical location of the affected fracture.
However, this study is in line with the studies of Yamamoto et al. 39 , Sahand Samieirad et al. 41 , Chee Wei Lee et al. 43 who showed ORIF as the most common treatment for maxillofacial fractures. Surgeons prefer ORIF because it offers the advantage of stable and precise reduction of anatomical fragments, allows for immediate recovery of function, as well as increased patient comfort. Indications for ORIF of a zygomatic complex fracture include diplopia, enophthalmus, poor aesthetics, poor aesthetics, and limited mouth opening. This treatment plan will reduce the bone healing period and the recovery period 41,42,43 .

Conclusion
Maxillofacial fracture are found commonly in men (80.3%). Most patient age ranges. is the age of 12-21 years (38.2%). The most common cause is traffic accidents (79.7%). The most frequently affected fracture site is on the midface (61.7%), where the most commonly affected bone is t he zygomaticomaxillaris complex (35.9%). The treatment option most often applied is ORIF (66.2%).