Occurence and Patterns of Maxillofacial Fractures at Moi Teaching and Referral Hospital, Kenya.

Occurence and Patterns of Maxillofacial Fractures at Moi Teaching and Referral Hospital, Kenya. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Occurence and Patterns of Maxillofacial Fractures at Moi Teaching and Referral Hospital, Kenya. Meshack Kipruto Korir, Cyrus Micha, Maged Lotfy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4618049/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Maxillofacial fractures attributed to physical trauma are a major cause of morbidity and mortality, with a rising prevalence in Kenya. This has been attributed to the increasing use of motorized transport, maxillofacial fractures secondary to assault, sport and occupational injuries as well as an increase in the aging population. Currently, there are few local empirical studies describing the patterns of these injuries and their associated factors. Objective: This study aimed to determine the occurrence and patterns of maxillofacial fractures at Moi Teaching and Referral Hospital (MTRH). It also described the patients’ sociodemographic characteristics and assessed for an association between etiology and pattern of maxillofacial fractures. Methodology: A descriptive cross-sectional study conducted at the departments of dentistry, emergency and surgical wards of MTRH among 206 patients diagnosed with maxillofacial fractures who were sampled systematically. Physical examination and assessment of the clinical investigations were performed prior to enrollment. Sociodemographic characteristics, injury history and fracture classification data were collected using a semi-structured questionnaire. Descriptive data analysis included frequencies and proportions (%), mean and standard deviation (SD). Inferential analysis included Pearson’s chi-square test to determine the association between etiology (independent variable) and pattern (dependent variable) of maxillofacial fractures using a critical value of p≤0.05 using Statistical Package for Social Sciences (SPSS) software, version 26. Results: A majority (86.9%; n=179) were male with the rest (13.1%; n=27) being female. The mean age was 30.8 (±11.3) years. 51.0% were married, 98.5% were Christians, 57.3% had at least a secondary level of education and 14.6% were formally employed. Majority were victims of motorcycle (55.5%) or motor vehicle (16.3%) accidents with the rest being victims of either falls, assaults, or sports-related injuries. Four-fifths of them (80.9%) did not have any protective gear at the time of injury. Fracture of the mandible (27.6%) were the most common, followed by fractures of the zygoma arch (18.4%), zygoma body (14.1%), maxilla (13.7%), orbital wall (11.1%), supraorbital (8.0%) and orbital floor (7.1%). Furthermore, 72 (35.0%) participants sustained multiple fractures on a single bone. Fractures on the upper third of the face were at 7.7%, middle third of the face (60.8%), lower-third of the face (24.1%), combined and other fractures accounted for 7.4%. Motorized transport (motorcycle and motor vehicle) accidents were significantly associated with fractures of the orbital wall (p=0.023) and maxilla (p=0.003) as well as multiple fractures (p=0.006). Conclusions: This study reports that majority of those presenting with maxillofacial fractures were male, married, self-employed and at least secondary level of education. About three quarters of the participants were victims of motorized transport (motorcycle) accidents. The most commonly fractured maxillofacial site was the mandible. Etiology was associated with the pattern of maxillofacial fractures seen. Recommendations: There is need for targeted information among young male adult motorcycle riders aged 30 years and below on maxillofacial injuries and prevention approaches such as using protective gear. Proper planning and procurement of the specific armamentarium is needed in the management of maxillofacial fractures. Dentistry Maxillofacial injuries Western Kenya Mandible fracture Le Fort. Figures Figure 1 INTRODUCTION The Maxillofacial region constitutes the upper jaw (maxilla), entire face not excluding the moveable part of the jaw (mandible) and the cheek prominence (zygomatic bone). It also includes the nasal, ethmoid and frontal bones 1 . The maxillofacial region is made up of three main parts: the upper third face, mid third face and lower third face 2 . The lower third of the face comprise the mandible along with its dento-alveolar arch 3 . The middle third is superiorly at the level of supraorbital margins and the occlusal plane of the upper teeth inferiorly (that include the maxilla, orbits, zygoma, and nasal bone). The upper third of the face comprises the region above the supraorbital margins 4 . Maxillofacial fractures are also classified using the Le Fort I, II and III system 5 . Concomitant fractures can occur on the head and neck regions of the affected victim. 6 These regions are made of both vital and complex anatomical structures whose fractures could initiate a cascade of complication to the central nervous, respiratory and gastrointestinal systems that could be fatal. 6 Because of the maxillofacial anatomical protuberance, it is prone to trauma that could lead to fractures on its hard tissues. 7 A proper understanding of the socioeconomic and clinical factors associated with maxillofacial fractures could inform prevention and treatment strategies for this health condition. The distribution of maxillofacial trauma data is disparate and spread across different sections in the healthcare continuum such as surgical and dental units. There is need for consolidation of this data to be able to determine the occurrence and patterns of fractures and to inform maxillofacial surgeons and other healthcare professionals on the frequency of specific fractures as well as probable intervention techniques. Furthermore, because these patterns vary across different countries, consolidation will enable healthcare providers and policy makers to optimally allocate and distribute the required resources. In teaching hospital in Kenya such as Moi Teaching and Referral Hospitals, the characteristics of patients with maxillofacial fractures, patterns of injury and their associated etiological factors have not been adequately documented, necessitating a local study to inform both management and the likely ways of prevention of these fractures. Furthermore, there are few local empirical studies describing the patterns of these injuries and their associated factors. This limited knowledge on patterns and associated factors of maxillofacial fractures interferes with the patient surgical management cascade as the required armamentarium may not be procured on time. This creates a reactionary rather than a predictive management approach to maxillofacial fractures, further interfering with patient outcomes. Some of the adverse surgical outcomes that may be experienced could include post-surgical infections, malunion, nonunion and delayed union. MATERIALS AND METHODS This cross-sectional descriptive study was conducted on patients with a history of maxillofacial trauma presenting at the maxillofacial department of Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, between August 2021 and July 2022. An initial review involved physical examination and assessment of the clinical investigations that had been performed. The clinical investigations of interest including medical imaging (OPG, CT scans, IOPA and standard occlusal). Sociodemographic characteristics, injury history and fracture classification data were collected using a semi-structured questionnaire. Descriptive data analysis included frequencies and proportions (%), mean and standard deviation (SD). Inferential analysis included Pearson’s chi-square test to determine the association between etiology (independent variable) and pattern (dependent variable) of maxillofacial fractures using a critical value of p ≤ 0.05 using Statistical Package for Social Sciences (SPSS) software, version 26. Ethical approval (#0003935) was obtained from the Institutional Research and Ethics Committee (IREC) of Moi Teaching and Referral Hospital and a research permit (NACOSTI/P/21/13958) from the National Commission of Science, Technology and Innovation (NACOSTI). A written informed consent was obtained from all adults prior to enrolment in the study. Individuals younger than 18 years (age of consent) obtained parental consent as well as assent prior to enrolment. Assent forms were stratified by age groups as 7 to 13 years old and 14 to 17 years old. For those younger than 7 years, only parental consent was obtained. RESULTS We enrolled 206 individuals with a mean age of 30.83 (± 11.28) years diagnosed with a maxillofacial injury. There were nearly equal proportions of married and single individuals, with nearly all those enrolled identifying as Christian. 42.6%(n = 89) attained primary education, followed by tertiary level of education (Table 1 ). Table 1 Sociodemographic Characteristics Sociodemographic Characteristic n (%) Age in years (Mean (SD) 30.83 (± 11.28) Gender Male Female 179 (86.9) 27 (13.1) Marital status Married Not Married 105 (51.0) 101 (49.0) Level of Education Primary Secondary Tertiary 88 (42.7) 40 (19.4) 78 (37.9) Employment status Formal Self-employed Unemployed 30 (14.6) 86 (41.7) 90 (43.7) Religion Christian Muslim 203 (98.5) 3 (1.5) Majority were involved in a motorcycle (55.5%) followed by motor vehicle (16.3%) accident. There were low proportions of assault (12.4%), activities of daily life (5.3%), work-related injuries (4.3%), bicycle and sports injuries at 2.9% each. At the time of injury, 82 (39.8%) and 47 (22.8%) were riders and passengers respectively. There were 424 bone fractures identified, of which fractures of the mandible (27.6%; n = 117) were the most common. This was followed by fractures on the zygomatic arch (18.4%), zygoma body (14.1%), maxilla (13.6%), orbital wall (11.0%), supraorbital (8.0%) and orbital floor (7.1%) as shown in Fig. 1 and Table 2 . Table 2 Maxillofacial bone fractures patterns (N = 424) Fracture Site n (%) Right Left Both Supraorbital 34 (8.0) 19 9 6 Zygoma body 60 (14.1) 24 31 5 Zygomatic arch 78 (18.4) 36 34 8 Orbit wall 47 (11.0) 17 17 13 Orbital floor 30 (7.1) Maxilla 58 (13.6) 20 16 22 Mandible 117 (27.8) 53 34 30 When patterns of maxillofacial fractures were further classified, more than half (53.4%; n = 110) were on isolated bones (Hard tissue), followed by multiple fractures on a single bone at 35.0% (n = 72) and panfacial fractures at 11.6% (n = 24). Fractures on the upper third of the face were at 7.7%, middle third of the face (60.8%), lower-third of the face (24.1%), combined and other fractures accounted for 7.4% (Table 3 ). Furthermore, 80.9% of the participants did not have any protective gear at the time of injury (Table 3 ). Table 3 Fracture site anatomical classification(N = 512) Anatomical region: n(%) Right Side Left Side Both sides 1 Upper Third of the Face (7.7%) Frontal bone 39 (7.7) 14 16 9 2 Mid- Third of the Face (60.8%) Orbit 47 (9.2) 17 17 13 Zygoma 55 (10.7) 22 27 6 Zygomatic Arch 80 (15.7) 38 34 8 Nasal bone fracture 24 (4.7) 8 1 15 Maxilla 58 (11.3) Le Fort I 14 (2.8) Le Fort II 16 (3.2) Le Fort III 16 (3.2) 3 Lower Third (24.1%) Body 43 (8.4) Symphysis 34 (6.6) Alveolar process 19 (3.6) Angle 9 (1.7) Condyle Fractures 7 (1.3) Parasympheseal 6 (1.1) Coronoid Process 5 (0.9) Ramus 3 (0.5) Other Fracture of the Skull Parietal 7 (1.4) 2 4 1 Temporal 5 (1.0) 2 2 1 Occipital 1 (0.2) 4 Panfacial (4.8%) 24 (4.8) Lastly, we categorized the etiology of maxillofacial fractures as either from motorized or non-motorized transport. Majority of the participants, 148 (71.8%) had been involved in a motorized transport (vehicles and motorcycles) accident with the rest, 58 (28.2%) being victims of non-motorized transport accidents. When a test of association was conducted, it was noted that there were significantly association between motorized transport accidents and fractures on the orbital wall (p = 0.017), maxilla (p = 0.003), lower third of the face (p < 0.001) and multiple fractures (p = 0.004) as shown on Table 4 . Table 4 Predictors of maxillofacial fractures. Etiology of Maxillofacial fracture (%) Pattern (outcome) OR (95% CI:)/ p-value Motorized Transport (85.1) Orbital Wall Fractures (n = 47) 1.269 (1.080, 1.491) p = 0.017 Non-motorized (14.9) Motorized Transport (86.2) Maxilla Fractures (n = 58) 1.319 (1.129, 1.542) p = 0.003 Non-motorized (13.8) Motorized Transport (83.6) Multiple single bone fractures (n = 72) 1.291 (1.100, 1.516) p = 0.004 Non-motorized (16.4) Motorized Transport (68.3) Lower third – Mandible (n = 125) p < 0.001 Non-motorized (31.7) Motorized Transport (76.9) Frontal Bone Fractures (n = 39) 1.099 (0.901, 1.340) p = 0.438 Non-motorized (23.2) DISCUSSION The mean age of this study’s participants was 30.83 (± 11.28) years a finding like all studies under review. 8 – 11 In Nairobi-Kenya 10 , the mean age of pedestrians enrolled was 31.48 (± 13.35), a finding that was close to that reported in Naivasha 12 at 33 years. Similarly, in a National survey in Kenya, the authors 9 reported that approximately half (42.2%) were aged between 18–29 years, while in the Kingdom of Saudi Arabia, most participants were aged between 31–40 years. In a similar study in Qatar the mean age of patient admitted or managed with maxillofacial fractures was 31.4 (± 14). In addition, less than half (42.7%) of this study participants only studied to primary school level compared to the rest having some form of secondary and tertiary education. However, the findings contrast two other studies under comparison where in the first 9 , 54.7% had primary level of education while in the second 12 58.3% reported to have attended only primary level of education. This difference could be attributed to temporal differences in when the two studies under comparison were conducted. Over time, Kenya has insisted on universal transition to secondary schools as well as created more tertiary education institutions to increase access. Since this study was conducted in the year 2022, it could be hypothesized that some participants may have benefited from these government policies and initiatives. There was a greater proportion of male participants (86.9%) presenting with maxillofacial fractures compared to their female counterparts at 13.1%. This disparity was also noted in Naivasha 12 at 82.3% for males, 76.9% in Nairobi, national STEPs survey average in Kenya at 60.3% 9 and 84.03% in Saudi Arabia. At a national hospital in Qatar, the authors also found out male gender predominance (93%) in their third and fourth decade of lives (33% and (22%) respectively had maxillofacial fractures with very minimal cases of maxillofacial trauma in children and elderly population. This study further notes that slightly more than half (51.0%) of those enrolled with maxillofacial fractures at MTRH were married, a finding that is lower than national survey at 63.6% 9 and 72.3% in Naivasha 12 . This finding corresponds to the mean age of 30 years, as most young adults marry within this age bracket. The study then assessed activity at the time of injury for those presenting with maxillofacial injuries at MTRH. Of note is that 40.2% were motorcycle riders, followed by passengers or pillion (whether in a motorcycle or a vehicle) at 22.5%, drivers (10%) and pedestrians (4.8%). This low proportion of pedestrians matches that reported in Malaysia and a retrospective study of a Trauma Register of the German Trauma Society 13 at 3.6% and 13.5% respectively. However, these findings contrast a national survey conducted in Kenya 9 where passengers accounted for 42.7%, followed by drivers (25.2%) and riders (20.2%). Furthermore, the findings in this study contrast that reported in Naivasha, where 45.9% were pedestrians, followed by riders (22.8%), passengers (11.2%) and drivers (2.1%). This study reports that more than half (55.5%) of all the participants sustained maxillofacial fractures following a motorcycle accident. This finding is comparable to that reported in Malaysia, where the authors reported that maxillofacial fractures accounted for 73.6% of all fractures seen. The findings also matched that of a local study conducted in Nairobi County 14 where 51.7% of the participants with maxillofacial injuries were sustained after a motorcycle accident. However, lower proportion of maxillofacial fractures attributed to motorcycle accidents were reported in Rwanda 15 at 24.7%. This contradicts a study done in Qatar whereby the most predominant causes of maxillofacial fractures were because of motor vehicle crush (MVC) at 39%. The wide variation of etiology of maxillofacial fractures in this study and others in developing countries could be described by mostly geographic variation and socioeconomic status of population in Qatar and Kenya as well as most preferred means of motorized transport among the study population of the two countries under study. Younger group in this study use motorcycles for their day-to-day income with most of the roads being in deplorable state compared to Qatar. Again, the safety rules and regulation of road users in this study could point out to laxity by authorities compared to Qatar. This prevalence of mandibular fractures of 27.6% is close to that reported in three studies under comparison. In India, 16 the prevalence of mandibular fractures stood at 33.57% while in Malaysia, the authors reported that 31.5% of individuals presenting with maxillofacial fractures had it on the mandible in the current study. An Iranian study had contrasting findings with mandibular fracture leading at 64.7% while zygomatic-maxillary complex recording 21.1%. In a study conducted in Syria after the civil war 17 , the highest proportion of study participants (66.9%) presented with mandibular fractures, a finding that contrasts that presented in this study. The high proportion of mandibular fractures reported in this study could be attributed to its anatomic disadvantage where the mandibular prominence and most patient who were involved in motor vehicle accident were trying to avoid injuries to the head and in the process receive much impact with great intensity to the mandible and thus many fractures to the mandible compared to other facial bones. With more disciplined drivers who fasten their safety belts they tend to have a reduction in maxillofacial fractures by avoiding impact on the dashboard, wind screen and steering wheel this is collaborated by a finding in a Libyan 18 study. Lower proportion of mandibular fractures were reported in a retrospective study conducted in Qatar 19 and a cross-sectional study Rwanda 15 at 22.5% and 19.8% respectively. When a test of association was conducted to assess the relationship between nature of injury and the anatomical location of the maxillofacial fracture, there was a statistically significant increased risk of orbital, orbital wall, Panfacial and multiple fractures for participants who were involved in a motor vehicle accident. The explanation to such finding as to why we have more risk on the orbit and orbital wall is the anatomic position which is disadvantaged by its prominence and protrusion relative to structures below it thus gets much impact at the time of a road accident. This finding is comparable to that reported in Japan 20 where a statistically significant association between trauma from motor vehicle accident and associated injuries. This being a cross-sectional descriptive study, it was not possible to determine the speed, high vs low energy impact and secondary effects of the maxillofacial injuries. Therefore, the findings of this study should be viewed considering this limitation. CONCLUSIONS AND RECOMMENDATIONS This study reports that majority of those presenting with maxillofacial fractures were male, married, self-employed and at least secondary level of education. About three quarters of the participants were victims of motorized transport (motorcycle) accidents. The most fractured maxillofacial site was the mandible. Etiology was associated with the pattern of maxillofacial fractures seen. There is need for targeted information among young male adult motorcycle riders aged 30 years and below on maxillofacial injuries and prevention approaches such as using protective gear. Proper planning and procurement of the specific armamentarium is needed in the management of maxillofacial fractures. References Brucoli M, Boccafoschi F, Boffano P, Broccardo E, Benech A (2018) The Anatomage Table and the placement of titanium mesh for the management of orbital floor fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 126:317–321 Romeo I et al (2022) A Multicentric Prospective Study on Maxillofacial Trauma Due to Road Traffic Accidents: The World Oral and Maxillofacial Trauma Project. J Craniofac Surg 33:1057–1062 Gupta P, Bansal S, Sinwar PD, Verma KA (2023) Retrospective Study of Maxillofacial Fractures at a Tertiary Care Centre in North India: A Review of 1674 Cases. J Maxillofac Oral Surg. 10.1007/S12663-023-01858-Y Pillay L, Mabongo M, Buch B (2018) Prevalence and aetiological factors of maxillofacial trauma in a rural district hospital in the Eastern Cape. South Afr Dent J 73:348–353 Ruslin M, Wolff J, Boffano P, Brand HS, Forouzanfar T (2015) Dental trauma in association with maxillofacial fractures: An epidemiological study. Dent Traumatol 31:318–323 Goodenough CJ et al (2020) Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An Under-Recognized Problem. J Craniofac Surg 31:775–777 Philip G, Dominic S, Poorna T, A., EK J (2022) Pattern of maxillofacial fractures in a Tertiary Referral Centre in Central Kerala - A comparison between the Pre-COVID and COVID periods. J Oral Biol Craniofac Res 12:45–48 Alqahtani F, Bishawi K, Jaber M (2020) Analysis of the pattern of maxillofacial injuries in Saudi Arabia: A systematic review. Saudi Dent J 32:61–67 Gathecha GK et al (2018) Prevalence and predictors of injuries in Kenya: findings from the national STEPs survey. BMC Public Health 18:1222 Ogendi J, Odero W, Mitullah W, Khayesi M (2013) Pattern of pedestrian injuries in the city of nairobi: Implications for urban safety planning. J Urb Health 90:849–856 Wilberforce C, Odero W, Menya D (2015) Commercial Bicyclist Injuries In Kisumu City, Kenya : An Epidemiology of a Neglected Problem. Int J Innov Sci Res 14:228–235 Cholo WO, Nyamusi E, Odero W (2015) Incidence of Road Traffic Crashes and Pattern of Injuries among Commercial Motorcyclists in Naivasha Town. Int J Appl Res 1:541–549 Pietzka S et al (2020) Maxillofacial injuries in severely injured patients after road traffic accidents—a retrospective evaluation of the TraumaRegister DGU® 1993–2014. Clin Oral Investig 24:503–513 Simba NJ (2015) Occurrence and Pattern of Maxillofacial Injuries Caused By Motorcycle Crashes Presenting At Two Referral Hospitals in Nairobi, Kenya Majambo MH et al (2014) Prevalence of Oral and Maxillofacial Injuries among patients Managed at Teaching Hospital in Rwanda. IOSR J Dent Med Sci 13:45–48 Pandey S et al (2015) Study of the Pattern of Maxillofacial Fractures Seen at a Tertiary Care Hospital in North India. J Maxillofac Oral Surg 14:32 Ucak M (2019) Incidence and severity of maxillofacial injuries during the Syrian civil war in Syrian soldiers and civilians. J Craniofac Surg 30:992–995 Elarabi MS, Bataineh AB (2018) Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya. Med Oral Patol Oral Cir Bucal 23:e248–e255 Al-Hassani AA, Ahmad K, El-Menyar A (2019) Prevalence and patterns of maxillofacial trauma: a retrospective descriptive study. Eur J Trauma Emerg Surg 45 Segura-Palleres I et al (2022) Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study. Dent Traumatol 38:213–222 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4618049","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":381373558,"identity":"ba4404b9-6e14-4d6a-b960-645ce7478be6","order_by":0,"name":"Meshack Kipruto Korir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBACCWYIbcDAwNjAwHAgQQ7EO/CAoJYEhBZjsJYEfFoY4FogahMbIAK4gWQ777HPvD9sjPmlD7d9YDiTlj4/7PBDoC12croN2LVIM/Mlz+ZJSDOT7EtsnsFwIyd34+00A6CWZGOzA9i1yDHzGDPzJBy2MTjD2MzA8KEid+PsBJCWA4nbiNWSbjg7/QNeLdJQLWYQLTdyEuSlc/DbItnMl8w4Jy3NWLIHqCXhTJrhBumcggMJBrj9InH+7GGGNzY2hv087I8ZPhxLlpefnb75w4cKOzlcWhgYeJDYCUBsAFZpgEs5uhYQkG/Ap3oUjIJRMApGIgAAN2paeKkvd/0AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-2258-0408","institution":"Moi University","correspondingAuthor":true,"prefix":"","firstName":"Meshack","middleName":"Kipruto","lastName":"Korir","suffix":""},{"id":381373559,"identity":"5413d370-a0ad-44f5-b77a-9e50ea92ecbf","order_by":1,"name":"Cyrus Micha","email":"","orcid":"https://orcid.org/0000-0002-4229-3310","institution":"Moi University","correspondingAuthor":false,"prefix":"","firstName":"Cyrus","middleName":"","lastName":"Micha","suffix":""},{"id":381373560,"identity":"811c8edc-39b2-46af-b7bd-b5dbd8217777","order_by":2,"name":"Maged Lotfy","email":"","orcid":"","institution":"Moi University","correspondingAuthor":false,"prefix":"","firstName":"Maged","middleName":"","lastName":"Lotfy","suffix":""}],"badges":[],"createdAt":"2024-06-21 14:45:01","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4618049/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4618049/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69831684,"identity":"0709bc6c-4487-49ae-8f8d-47715523c06b","added_by":"auto","created_at":"2024-11-25 15:39:15","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":220060,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnatomy of the Maxillofacial Region (source: )\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4618049/v1/2fa58a488e8a93ee64bf7857.jpeg"},{"id":69831892,"identity":"76683e8f-83a5-4b69-a42c-b2ece81d6838","added_by":"auto","created_at":"2024-11-25 15:39:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":700323,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4618049/v1/b2e8259b-8d0d-4141-b783-30030c64663a.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eOccurence and Patterns of Maxillofacial Fractures at Moi Teaching and Referral Hospital, Kenya.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe Maxillofacial region constitutes the upper jaw (maxilla), entire face not excluding the moveable part of the jaw (mandible) and the cheek prominence (zygomatic bone). It also includes the nasal, ethmoid and frontal bones\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The maxillofacial region is made up of three main parts: the upper third face, mid third face and lower third face\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The lower third of the face comprise the mandible along with its dento-alveolar arch\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The middle third is superiorly at the level of supraorbital margins and the occlusal plane of the upper teeth inferiorly (that include the maxilla, orbits, zygoma, and nasal bone). The upper third of the face comprises the region above the supraorbital margins\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Maxillofacial fractures are also classified using the Le Fort I, II and III system\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Concomitant fractures can occur on the head and neck regions of the affected victim.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e These regions are made of both vital and complex anatomical structures whose fractures could initiate a cascade of complication to the central nervous, respiratory and gastrointestinal systems that could be fatal.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Because of the maxillofacial anatomical protuberance, it is prone to trauma that could lead to fractures on its hard tissues.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e A proper understanding of the socioeconomic and clinical factors associated with maxillofacial fractures could inform prevention and treatment strategies for this health condition. The distribution of maxillofacial trauma data is disparate and spread across different sections in the healthcare continuum such as surgical and dental units. There is need for consolidation of this data to be able to determine the occurrence and patterns of fractures and to inform maxillofacial surgeons and other healthcare professionals on the frequency of specific fractures as well as probable intervention techniques. Furthermore, because these patterns vary across different countries, consolidation will enable healthcare providers and policy makers to optimally allocate and distribute the required resources. In teaching hospital in Kenya such as Moi Teaching and Referral Hospitals, the characteristics of patients with maxillofacial fractures, patterns of injury and their associated etiological factors have not been adequately documented, necessitating a local study to inform both management and the likely ways of prevention of these fractures. Furthermore, there are few local empirical studies describing the patterns of these injuries and their associated factors. This limited knowledge on patterns and associated factors of maxillofacial fractures interferes with the patient surgical management cascade as the required armamentarium may not be procured on time. This creates a reactionary rather than a predictive management approach to maxillofacial fractures, further interfering with patient outcomes. Some of the adverse surgical outcomes that may be experienced could include post-surgical infections, malunion, nonunion and delayed union.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis cross-sectional descriptive study was conducted on patients with a history of maxillofacial trauma presenting at the maxillofacial department of Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, between August 2021 and July 2022. An initial review involved physical examination and assessment of the clinical investigations that had been performed. The clinical investigations of interest including medical imaging (OPG, CT scans, IOPA and standard occlusal). Sociodemographic characteristics, injury history and fracture classification data were collected using a semi-structured questionnaire. Descriptive data analysis included frequencies and proportions (%), mean and standard deviation (SD). Inferential analysis included Pearson\u0026rsquo;s chi-square test to determine the association between etiology (independent variable) and pattern (dependent variable) of maxillofacial fractures using a critical value of p\u0026thinsp;\u0026le;\u0026thinsp;0.05 using Statistical Package for Social Sciences (SPSS) software, version 26. Ethical approval (#0003935) was obtained from the Institutional Research and Ethics Committee (IREC) of Moi Teaching and Referral Hospital and a research permit (NACOSTI/P/21/13958) from the National Commission of Science, Technology and Innovation (NACOSTI). A written informed consent was obtained from all adults prior to enrolment in the study. Individuals younger than 18 years (age of consent) obtained parental consent as well as assent prior to enrolment. Assent forms were stratified by age groups as 7 to 13 years old and 14 to 17 years old. For those younger than 7 years, only parental consent was obtained.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWe enrolled 206 individuals with a mean age of 30.83 (\u0026plusmn;\u0026thinsp;11.28) years diagnosed with a maxillofacial injury. There were nearly equal proportions of married and single individuals, with nearly all those enrolled identifying as Christian. 42.6%(n\u0026thinsp;=\u0026thinsp;89) attained primary education, followed by tertiary level of education (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSociodemographic Characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge in years (Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.83 (\u0026plusmn;\u0026thinsp;11.28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179 (86.9)\u003c/p\u003e \u003cp\u003e27 (13.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eNot Married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (51.0)\u003c/p\u003e \u003cp\u003e101 (49.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (42.7)\u003c/p\u003e \u003cp\u003e40 (19.4)\u003c/p\u003e \u003cp\u003e78 (37.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFormal\u003c/p\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (14.6)\u003c/p\u003e \u003cp\u003e86 (41.7)\u003c/p\u003e \u003cp\u003e90 (43.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e203 (98.5)\u003c/p\u003e \u003cp\u003e3 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMajority were involved in a motorcycle (55.5%) followed by motor vehicle (16.3%) accident. There were low proportions of assault (12.4%), activities of daily life (5.3%), work-related injuries (4.3%), bicycle and sports injuries at 2.9% each. At the time of injury, 82 (39.8%) and 47 (22.8%) were riders and passengers respectively. There were 424 bone fractures identified, of which fractures of the mandible (27.6%; n\u0026thinsp;=\u0026thinsp;117) were the most common. This was followed by fractures on the zygomatic arch (18.4%), zygoma body (14.1%), maxilla (13.6%), orbital wall (11.0%), supraorbital (8.0%) and orbital floor (7.1%) as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaxillofacial bone fractures patterns (N\u0026thinsp;=\u0026thinsp;424)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture Site\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupraorbital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygoma body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygomatic arch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrbit wall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrbital floor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen patterns of maxillofacial fractures were further classified, more than half (53.4%; n\u0026thinsp;=\u0026thinsp;110) were on isolated bones (Hard tissue), followed by multiple fractures on a single bone at 35.0% (n\u0026thinsp;=\u0026thinsp;72) and panfacial fractures at 11.6% (n\u0026thinsp;=\u0026thinsp;24). Fractures on the upper third of the face were at 7.7%, middle third of the face (60.8%), lower-third of the face (24.1%), combined and other fractures accounted for 7.4% (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Furthermore, 80.9% of the participants did not have any protective gear at the time of injury (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFracture site anatomical classification(N\u0026thinsp;=\u0026thinsp;512)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAnatomical region:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRight Side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLeft Side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBoth sides\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUpper Third of the Face\u003c/b\u003e (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrontal bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u003cb\u003eMid- Third of the Face\u003c/b\u003e (60.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrbit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZygoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZygomatic Arch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNasal bone fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLe Fort I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLe Fort II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLe Fort III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"11\" rowspan=\"12\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"11\" rowspan=\"12\"\u003e \u003cp\u003e\u003cb\u003eLower Third\u003c/b\u003e (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSymphysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlveolar process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAngle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCondyle Fractures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParasympheseal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoronoid Process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRamus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eOther Fracture of the Skull\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParietal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTemporal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOccipital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePanfacial\u003c/b\u003e (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLastly, we categorized the etiology of maxillofacial fractures as either from motorized or non-motorized transport. Majority of the participants, 148 (71.8%) had been involved in a motorized transport (vehicles and motorcycles) accident with the rest, 58 (28.2%) being victims of non-motorized transport accidents. When a test of association was conducted, it was noted that there were significantly association between motorized transport accidents and fractures on the orbital wall (p\u0026thinsp;=\u0026thinsp;0.017), maxilla (p\u0026thinsp;=\u0026thinsp;0.003), lower third of the face (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and multiple fractures (p\u0026thinsp;=\u0026thinsp;0.004) as shown on Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of maxillofacial fractures.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology of Maxillofacial fracture (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePattern\u003c/p\u003e \u003cp\u003e(outcome)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95% CI:)/\u003c/p\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotorized Transport\u003c/b\u003e (85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOrbital Wall Fractures (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.269 (1.080, 1.491)\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-motorized\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(14.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotorized Transport\u003c/b\u003e (86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMaxilla Fractures (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.319 (1.129, 1.542)\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-motorized\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(13.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotorized Transport\u003c/b\u003e (83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMultiple single bone fractures (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.291 (1.100, 1.516)\u003c/p\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-motorized\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(16.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotorized Transport\u003c/b\u003e (68.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLower third \u0026ndash; Mandible (n\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-motorized\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotorized Transport\u003c/b\u003e (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFrontal Bone Fractures (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.099 (0.901, 1.340)\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-motorized\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(23.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe mean age of this study\u0026rsquo;s participants was 30.83 (\u0026plusmn;\u0026thinsp;11.28) years a finding like all studies under review.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In Nairobi-Kenya\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, the mean age of pedestrians enrolled was 31.48 (\u0026plusmn;\u0026thinsp;13.35), a finding that was close to that reported in Naivasha\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e at 33 years. Similarly, in a National survey in Kenya, the authors\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e reported that approximately half (42.2%) were aged between 18\u0026ndash;29 years, while in the Kingdom of Saudi Arabia, most participants were aged between 31\u0026ndash;40 years. In a similar study in Qatar the mean age of patient admitted or managed with maxillofacial fractures was 31.4 (\u0026plusmn;\u0026thinsp;14). In addition, less than half (42.7%) of this study participants only studied to primary school level compared to the rest having some form of secondary and tertiary education. However, the findings contrast two other studies under comparison where in the first \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, 54.7% had primary level of education while in the second\u003csup\u003e12\u003c/sup\u003e 58.3% reported to have attended only primary level of education. This difference could be attributed to temporal differences in when the two studies under comparison were conducted. Over time, Kenya has insisted on universal transition to secondary schools as well as created more tertiary education institutions to increase access. Since this study was conducted in the year 2022, it could be hypothesized that some participants may have benefited from these government policies and initiatives.\u003c/p\u003e\n\u003cp\u003eThere was a greater proportion of male participants (86.9%) presenting with maxillofacial fractures compared to their female counterparts at 13.1%. This disparity was also noted in Naivasha\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e at 82.3% for males, 76.9% in Nairobi, national STEPs survey average in Kenya at 60.3%\u003csup\u003e9\u003c/sup\u003e and 84.03% in Saudi Arabia. At a national hospital in Qatar, the authors also found out male gender predominance (93%) in their third and fourth decade of lives (33% and (22%) respectively had maxillofacial fractures with very minimal cases of maxillofacial trauma in children and elderly population. This study further notes that slightly more than half (51.0%) of those enrolled with maxillofacial fractures at MTRH were married, a finding that is lower than national survey at 63.6%\u003csup\u003e9\u003c/sup\u003e and 72.3% in Naivasha\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This finding corresponds to the mean age of 30 years, as most young adults marry within this age bracket.\u003c/p\u003e\n\u003cp\u003eThe study then assessed activity at the time of injury for those presenting with maxillofacial injuries at MTRH. Of note is that 40.2% were motorcycle riders, followed by passengers or pillion (whether in a motorcycle or a vehicle) at 22.5%, drivers (10%) and pedestrians (4.8%). This low proportion of pedestrians matches that reported in Malaysia and a retrospective study of a Trauma Register of the German Trauma Society\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e at 3.6% and 13.5% respectively. However, these findings contrast a national survey conducted in Kenya\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e where passengers accounted for 42.7%, followed by drivers (25.2%) and riders (20.2%). Furthermore, the findings in this study contrast that reported in Naivasha, where 45.9% were pedestrians, followed by riders (22.8%), passengers (11.2%) and drivers (2.1%).\u003c/p\u003e\n\u003cp\u003eThis study reports that more than half (55.5%) of all the participants sustained maxillofacial fractures following a motorcycle accident. This finding is comparable to that reported in Malaysia, where the authors reported that maxillofacial fractures accounted for 73.6% of all fractures seen. The findings also matched that of a local study conducted in Nairobi County\u003csup\u003e14 \u003c/sup\u003ewhere 51.7% of the participants with maxillofacial injuries were sustained after a motorcycle accident. However, lower proportion of maxillofacial fractures attributed to motorcycle accidents were reported in Rwanda\u003csup\u003e15 \u003c/sup\u003eat 24.7%. This contradicts a study done in Qatar whereby the most predominant causes of maxillofacial fractures were because of motor vehicle crush (MVC) at 39%. The wide variation of etiology of maxillofacial fractures in this study and others in developing countries could be described by mostly geographic variation and socioeconomic status of population in Qatar and Kenya as well as most preferred means of motorized transport among the study population of the two countries under study. Younger group in this study use motorcycles for their day-to-day income with most of the roads being in deplorable state compared to Qatar. Again, the safety rules and regulation of road users in this study could point out to laxity by authorities compared to Qatar.\u003c/p\u003e\n\u003cp\u003eThis prevalence of mandibular fractures of 27.6% is close to that reported in three studies under comparison. In India,\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e the prevalence of mandibular fractures stood at 33.57% while in Malaysia, the authors reported that 31.5% of individuals presenting with maxillofacial fractures had it on the mandible in the current study. An Iranian study had contrasting findings with mandibular fracture leading at 64.7% while zygomatic-maxillary complex recording 21.1%. In a study conducted in Syria after the civil war \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, the highest proportion of study participants (66.9%) presented with mandibular fractures, a finding that contrasts that presented in this study. The high proportion of mandibular fractures reported in this study could be attributed to its anatomic disadvantage where the mandibular prominence and most patient who were involved in motor vehicle accident were trying to avoid injuries to the head and in the process receive much impact with great intensity to the mandible and thus many fractures to the mandible compared to other facial bones. With more disciplined drivers who fasten their safety belts they tend to have a reduction in maxillofacial fractures by avoiding impact on the dashboard, wind screen and steering wheel this is collaborated by a finding in a Libyan\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e study. Lower proportion of mandibular fractures were reported in a retrospective study conducted in Qatar\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e and a cross-sectional study Rwanda\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e at 22.5% and 19.8% respectively. When a test of association was conducted to assess the relationship between nature of injury and the anatomical location of the maxillofacial fracture, there was a statistically significant increased risk of orbital, orbital wall, Panfacial and multiple fractures for participants who were involved in a motor vehicle accident. The explanation to such finding as to why we have more risk on the orbit and orbital wall is the anatomic position which is disadvantaged by its prominence and protrusion relative to structures below it thus gets much impact at the time of a road accident. This finding is comparable to that reported in Japan\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e where a statistically significant association between trauma from motor vehicle accident and associated injuries. This being a cross-sectional descriptive study, it was not possible to determine the speed, high vs low energy impact and secondary effects of the maxillofacial injuries. Therefore, the findings of this study should be viewed considering this limitation.\u003c/p\u003e"},{"header":"CONCLUSIONS AND RECOMMENDATIONS","content":"\u003cp\u003eThis study reports that majority of those presenting with maxillofacial fractures were male, married, self-employed and at least secondary level of education. About three quarters of the participants were victims of motorized transport (motorcycle) accidents. The most fractured maxillofacial site was the mandible. Etiology was associated with the pattern of maxillofacial fractures seen. There is need for targeted information among young male adult motorcycle riders aged 30 years and below on maxillofacial injuries and prevention approaches such as using protective gear. Proper planning and procurement of the specific armamentarium is needed in the management of maxillofacial fractures.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrucoli M, Boccafoschi F, Boffano P, Broccardo E, Benech A (2018) The Anatomage Table and the placement of titanium mesh for the management of orbital floor fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 126:317\u0026ndash;321\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomeo I et al (2022) A Multicentric Prospective Study on Maxillofacial Trauma Due to Road Traffic Accidents: The World Oral and Maxillofacial Trauma Project. J Craniofac Surg 33:1057\u0026ndash;1062\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta P, Bansal S, Sinwar PD, Verma KA (2023) Retrospective Study of Maxillofacial Fractures at a Tertiary Care Centre in North India: A Review of 1674 Cases. J Maxillofac Oral Surg. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S12663-023-01858-Y\u003c/span\u003e\u003cspan address=\"10.1007/S12663-023-01858-Y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePillay L, Mabongo M, Buch B (2018) Prevalence and aetiological factors of maxillofacial trauma in a rural district hospital in the Eastern Cape. South Afr Dent J 73:348\u0026ndash;353\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuslin M, Wolff J, Boffano P, Brand HS, Forouzanfar T (2015) Dental trauma in association with maxillofacial fractures: An epidemiological study. Dent Traumatol 31:318\u0026ndash;323\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodenough CJ et al (2020) Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An Under-Recognized Problem. J Craniofac Surg 31:775\u0026ndash;777\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhilip G, Dominic S, Poorna T, A., EK J (2022) Pattern of maxillofacial fractures in a Tertiary Referral Centre in Central Kerala - A comparison between the Pre-COVID and COVID periods. J Oral Biol Craniofac Res 12:45\u0026ndash;48\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlqahtani F, Bishawi K, Jaber M (2020) Analysis of the pattern of maxillofacial injuries in Saudi Arabia: A systematic review. Saudi Dent J 32:61\u0026ndash;67\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGathecha GK et al (2018) Prevalence and predictors of injuries in Kenya: findings from the national STEPs survey. BMC Public Health 18:1222\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgendi J, Odero W, Mitullah W, Khayesi M (2013) Pattern of pedestrian injuries in the city of nairobi: Implications for urban safety planning. J Urb Health 90:849\u0026ndash;856\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilberforce C, Odero W, Menya D (2015) Commercial Bicyclist Injuries In Kisumu City, Kenya : An Epidemiology of a Neglected Problem. Int J Innov Sci Res 14:228\u0026ndash;235\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCholo WO, Nyamusi E, Odero W (2015) Incidence of Road Traffic Crashes and Pattern of Injuries among Commercial Motorcyclists in Naivasha Town. Int J Appl Res 1:541\u0026ndash;549\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePietzka S et al (2020) Maxillofacial injuries in severely injured patients after road traffic accidents\u0026mdash;a retrospective evaluation of the TraumaRegister DGU\u0026reg; 1993\u0026ndash;2014. Clin Oral Investig 24:503\u0026ndash;513\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimba NJ (2015) Occurrence and Pattern of Maxillofacial Injuries Caused By Motorcycle Crashes Presenting At Two Referral Hospitals in Nairobi, Kenya\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajambo MH et al (2014) Prevalence of Oral and Maxillofacial Injuries among patients Managed at Teaching Hospital in Rwanda. IOSR J Dent Med Sci 13:45\u0026ndash;48\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePandey S et al (2015) Study of the Pattern of Maxillofacial Fractures Seen at a Tertiary Care Hospital in North India. J Maxillofac Oral Surg 14:32\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUcak M (2019) Incidence and severity of maxillofacial injuries during the Syrian civil war in Syrian soldiers and civilians. J Craniofac Surg 30:992\u0026ndash;995\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElarabi MS, Bataineh AB (2018) Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya. Med Oral Patol Oral Cir Bucal 23:e248\u0026ndash;e255\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Hassani AA, Ahmad K, El-Menyar A (2019) Prevalence and patterns of maxillofacial trauma: a retrospective descriptive study. Eur J Trauma Emerg Surg 45\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSegura-Palleres I et al (2022) Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study. Dent Traumatol 38:213\u0026ndash;222\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Moi University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maxillofacial injuries, Western Kenya, Mandible fracture, Le Fort.","lastPublishedDoi":"10.21203/rs.3.rs-4618049/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4618049/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMaxillofacial fractures attributed to physical trauma are a major cause of morbidity and mortality, with a rising prevalence in Kenya. This has been attributed to the increasing use of motorized transport, maxillofacial fractures secondary to assault, sport and occupational injuries as well as an increase in the aging population. Currently, there are few local empirical studies describing the patterns of these injuries and their associated factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aimed to determine the occurrence and patterns of maxillofacial fractures at Moi Teaching and Referral Hospital (MTRH). It also described the patients’ sociodemographic characteristics and assessed for an association between etiology and pattern of maxillofacial fractures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e A descriptive cross-sectional study conducted at the departments of dentistry, emergency and surgical wards of MTRH among 206 patients diagnosed with maxillofacial fractures who were sampled systematically. Physical examination and assessment of the clinical investigations were performed prior to enrollment. Sociodemographic characteristics, injury history and fracture classification data were collected using a semi-structured questionnaire. Descriptive data analysis included frequencies and proportions (%), mean and standard deviation (SD). Inferential analysis included Pearson’s chi-square test to determine the association between etiology (independent variable) and pattern (dependent variable) of maxillofacial fractures using a critical value of p≤0.05 using Statistical Package for Social Sciences (SPSS) software, version 26.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A majority (86.9%; n=179) were male with the rest (13.1%; n=27) being female. The mean age was 30.8 (±11.3) years. 51.0% were married, 98.5% were Christians, 57.3% had at least a secondary level of education and 14.6% were formally employed. Majority were victims of motorcycle (55.5%) or motor vehicle (16.3%) accidents with the rest being victims of either falls, assaults, or sports-related injuries. Four-fifths of them (80.9%) did not have any protective gear at the time of injury. Fracture of the mandible (27.6%) were the most common, followed by fractures of the zygoma arch (18.4%), zygoma body (14.1%), maxilla (13.7%), orbital wall (11.1%), supraorbital (8.0%) and orbital floor (7.1%). Furthermore, 72 (35.0%) participants sustained multiple fractures on a single bone. Fractures on the upper third of the face were at 7.7%, middle third of the face (60.8%), lower-third of the face (24.1%), combined and other fractures accounted for 7.4%. Motorized transport (motorcycle and motor vehicle) accidents were significantly associated with fractures of the orbital wall (p=0.023) and maxilla (p=0.003) as well as multiple fractures (p=0.006).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This study reports that majority of those presenting with maxillofacial fractures were male, married, self-employed and at least secondary level of education. About three quarters of the participants were victims of motorized transport (motorcycle) accidents. The most commonly fractured maxillofacial site was the mandible. Etiology was associated with the pattern of maxillofacial fractures seen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations: \u003c/strong\u003eThere is need for targeted information among young male adult motorcycle riders aged 30 years and below on maxillofacial injuries and prevention approaches such as using protective gear. Proper planning and procurement of the specific armamentarium is needed in the management of maxillofacial fractures.\u003c/p\u003e","manuscriptTitle":"Occurence and Patterns of Maxillofacial Fractures at Moi Teaching and Referral Hospital, Kenya.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-25 15:38:16","doi":"10.21203/rs.3.rs-4618049/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"932ce0a2-d437-4eb2-b7c2-a36d1ec1f235","owner":[],"postedDate":"November 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40713765,"name":"Dentistry"}],"tags":[],"updatedAt":"2024-11-25T15:38:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-25 15:38:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4618049","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4618049","identity":"rs-4618049","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}