Maxillofacial fractures sustained during sports played with a ball

doi:10.1016/j.tripleo.2003.10.008

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 97, Issue 1, January 2004, Pages 23-27

https://doi.org/10.1016/j.tripleo.2003.10.008 Get rights and content

Abstract

Objective

The aim of this study was to investigate the incidence and type of maxillofacial fractures caused by various sports played with a ball to better understand the nature of these fractures.

Study design

Retrospective study was carried out using records from 100 patients treated between 1986-2002. Age and sex, etiology, and site of the fracture, yearly and monthly distribution of the fractures, and treatment modality were analyzed.

Results

The fractures mostly resulted from baseball (44%), followed by rugby (28%) and soccer (18%). The highest incidence was in the 10- to 19-year age-group with male propensity. The most common cause of the fractures was impact against another player (43%). The majority of the patients suffered from mandibular fractures (56%), followed by midface (31%) and alveolar fractures (12%). Mandibular angle, zygoma, and zygomatic arch fractures were prominent for rugby fractures. A yearly comparison of the fracture incidence showed a gradual decrease over the 16-year period. Fractures had a peak incidence in autumn. 55% of the patients were treated surgically. Surgical intervention was mostly needed for patients sustaining fractures during soccer (72.2%).

Conclusions

Among ball-related sports, baseball is responsible for most of the maxillofacial fractures, but, although the incidence is not that high, soccer-related fractures may be more severe due to the nature of this sport.

Introduction

People are more prone to sports-related injuries parallel to increased popularity of sports and growing participation in various sports activities.1, 2, 3 It has been reported that 3-18% of all maxillofacial fractures are caused by sports and games.¹ Contact sports are more dangerous due to their nature, causing extensive and multiple injuries. Many sports and games played with a ball are popular throughout the world, as most of them can be performed both indoor and outdoor, and in all seasons. Research on etiology and extent of maxillofacial injury sustained during sports would be useful to focus on protective measures and to plan changes in legislation. A special field of sports medicine has been established, and sports dentistry has been defined that focuses upon preventive and therapeutic interventions for sports-related oral and maxillofacial injuries. There is a great need for understanding the nature of sports-related traumatic injuries. Sharing the clinical and epidemiological data will permit identification of causative factors for these injuries and development of effective preventive and therapeutic methods for the benefit of patients.

The aim of this study was to analyze maxillofacial fractures due to ball-related sports to evaluate the causes and to better understand the nature of these fractures.

Section snippets

Patients and methods

During the period between 1986 and 2002, 1428 patients with maxillofacial fractures were treated in the First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University. One-hundred-twenty-six patients sustained fractures during sports activities, 100 of which were related to sports played with a ball. A retrospective analysis of patients' files was carried out considering age and gender, cause and site of the fracture, the month and year the injury occurred,

Results

One-thousand-four-hundred-twenty-eight patients were treated with maxillofacial fractures. One-hundred-twenty-six patients (8.8%) had fractures due to sports activities. One-hundred of them (7% of all maxillofacial fractures and 79.3% of sports-related fractures) were due to ball-related sports. The fractures mostly resulted from baseball (44%), followed by rugby (28%), soccer (% 18), and other ball-related sports such as basketball, golf, tennis, and handball (10%).

Yearly and monthly distribution of the fractures

A yearly comparison of the fracture incidence due to ball-related sports showed a gradual decrease over the 16-year period (Fig 4). The highest incidence was seen in 1986 (94.1% of sports related fractures and 14.4% of all maxillofacial fractures), and the lowest incidence was in 2001 (no case). There was a yearly gradual decrease in baseball-related fractures as well. Fractures sustained during soccer and rugby tended to decrease in the last 2 years (no case). The incidence of ball-related

Treatment

Fifty-five of the 100 patients were treated by surgical intervention, including mini-plate and wire fixation. In 45 patients, non-surgical treatment was performed (ie, maxillomandibular fixation that continued for 4 to 6 weeks). Surgical intervention was used to treat 58.9% of the mandibular fractures and 67.7% of midface fractures. Of the patients treated surgically, 45.4%, 64.2% and 72.2% respectively were for baseball, rugby, and soccer-related fractures.

Discussion

The increased interest in sports has focused attention on attempts to prevent sports injuries in recent years. Fractures sustained during sports have lower incidence than those from other causes such as assaults, traffic accidents, and falls.1, 2, 5, 6 The incidence of maxillofacial fractures related to sports was reported to vary from 6-15% in Japan and 2.5-28% in other countries.² This rate tends to increase in high-contact sports since the facial region is more prone to injury in these

References (18)

J. Sane et al.
Sports-related maxillofacial fractures in a hospital material
Int J Oral Maxillofac Surg
(1988)
N. Tanaka et al.
Maxillofacial fractures sustained during sports
J Oral Maxillofac Surg
(1996)
C.M. Hill et al.
A one-year review of maxillofacial sports injuries treated at an accident and emergency department
Brit J Oral Maxillofac Surg
(1998)
S. Iida et al.
Retrospective analysis of 1502 patients with facial fractures
Int J Oral Maxillofac Surg
(2001)
R. Emshoff et al.
Trends in the incidents and cause of sport-related mandibular fracturesa retrospective analysis
J Oral Maxillofac Surg
(1997)
J. Sane et al.
Maxillofacial and dental soccer injuries in Finland
Brit J Oral Maxillofac Surg
(1987)
A. Frenguelli et al.
Head and neck trauma in sporting activities
J Cranio-Max-Fac Surg
(1991)
C.M. Hill et al.
Dental and facial injuries following sports accidentsa study of 130 patients
Brit J Oral Maxillofac Surg
(1985)
G. Cerulli et al.
Soccer-related craniomaxillofacial injuries
J Cranifac Surg
(2002)

There are more references available in the full text version of this article.

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The majority of sports-related maxillofacial injuries are managed by conservative treatment . Surgical treatment is found in high-energy sports that cause more severe injuries [12]. There is a large disparity among gender incidence, with males being affected 10 times or more than females [8,10,14,17,23,47,48].
Sports etiology is one of the most common causes of maxillofacial injuries. This work aimed to provide an up-to-date review of sports-related maxillofacial injuries.
An updated review was conducted on Pubmed and Google Scholar. No publication year and language restrictions were applied. Two different search strategies were performed, the first addressed which sports, generally associated with maxillofacial injuries, and the second search was conducted to determine the frequency of maxillofacial injuries associated with each sport individually.
The first search returned 26 articles distributed across different sports, from different countries, and with varied age distribution. The second search displayed 85 articles on individual sports group. Papers were rated and categorized according by the sport associated to the reported injury. A useful sports risk scale for maxillofacial injuries has been developed. Peculiar themes from all participating sports were evaluated. The use of protective equipment and other preventive measures were highlighted.
Some sports with ball and cycling can be considered riskier sports for maxillofacial injuries. Athlete education and the mandatory use of mouthguards, helmets, and eye protection, among other things, are crucial to prevent these injuries. Tailor-made mouthguards and protective masks, which are becoming cheaper, are in vogue. The Sports-related Maxillofacial Injuries Risk scale can be useful for athletes, athletic coaches, and maxillofacial surgeons.
Secondary prevention of nasal bone fractures by protective facemasks in athletes – A Comparative Retrospective Study of 19 Patients
2020, Science and Sports
Le sport, devenu incontournable dans notre société moderne, tant pour ses bienfaits sur le plan de la santé que sur le plan social et relationnel, est un grand pourvoyeur de traumatismes maxillo-faciaux. L’objectif de notre travail est de montrer l’intérêt de l’utilisation du masque de protection faciale chez les sportifs en prévention secondaire d’un traumatisme de la région nasale, d’en établir les règles d’utilisation (conception et forme, durée de port) et d’évaluer le sentiment de protection du joueur.
Une étude comparative rétrospective a été réalisée entre le 1er janvier 2013 et le 31 décembre 2015 à propos de 19 patients dans les services de chirurgie maxillo-faciale du CHU de Caen et de Nantes. Ces deux services ont une attitude qui diffère concernant la prise en charge post-traumatique des sportifs : l’un propose une reprise précoce avec masque de protection, l’autre préconise une dispense de sport de 6 semaines (sans port de masque).
Les résultats de notre étude et de la revue de la littérature suggèrent l’utilisation de ces masques de protection faciale en prévention secondaire des fractures de la région nasale chez les sportifs souhaitant un retour rapide à la compétition.
Sport, become inescapable in our modern society, both for its healthy, social and relational benefits, is a major provider of maxillofacial trauma. The objective of our work is to show the interest of the facial mask in secondary prevention for fracture of nasal region, to establish rules of use (design and shape, wearing time) and to estimate the feeling of protection for the player.
A retrospective comparative study was realized between January 1st, 2013 and December 31st, 2015 about 19 patients in the departments of maxillofacial surgery of the University Hospital of Caen and Nantes. These two departments have a different attitude to manage the post-traumatic care of the sportsmen, the one proposing a premature resumption with protective mask, the other one recommending a sporting exemption of 6 weeks (without mask).
Our results and review of the literature suggest that the use of these facial protections in secondary prevention for fractures of nasal region can be used for a faster return to the competition.
Facial fractures in football: incidence, site, and mechanism of injury
2016, British Journal of Oral and Maxillofacial Surgery
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Mandibular fractures accounted for 54, with the mandibular angle being the most common site. These patterns of fractures are similar to those reported in previous studies.2,6,8,12 We saw no bimaxillary fractures.
Football injuries are responsible for many of the maxillofacial injuries sustained during sporting activities. In the Australian Capital Territory (ACT), the four major types of Australian football are played in large numbers and up to a high standard. Our objective was to analyse maxillofacial fractures that were sustained during rugby league, rugby union, Australian rules, and soccer matches. We retrospectively studied 134 patients with maxillofacial fractures during the five-year period 2010-14. All patients were assessed and treated at Canberra Hospital, the major trauma centre in the ACT. Data collected from patients’ records included type of football, age, sex, mechanism of injury, site of injury, and treatment. The number of people registered to play was obtained from each football governing body to find out the incidence of fractures. League had the highest incidence of facial fractures, followed by union, Australian rules, and soccer. High speed and high collision football (league and union) had a higher rate of mandibular fractures than high speed and low contact football (Australian rules and soccer) (n = 43, 45% compared with n = 7, 21%). Australian rules and soccer had a higher incidence of midface fractures than league and union (n = 26, 79%, compared with n = 52, 55%). Clash of heads was the leading cause of fractures. Collisions against other players’ shoulders and forearms were more likely to cause mandible fractures. Ninety-four patients (70%) required surgical intervention. Football-related maxillofacial fractures occur regularly, and different types of football have predictable patterns of injury. Padding of the heads and elbows of players may reduce the number and seriousness of facial fractures.
Prevalence of signs and symptoms of temporomandibular dysfunction in female adolescent athletes and non-athletes
2013, International Journal of Pediatric Otorhinolaryngology
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The fractures resulted mostly from ball sports (74%), especially soccer (59%), followed by handball (8%) and basketball (1.4%). According to many studies [23–28], teenagers account for the greatest number of these injuries, due primarily to increased participation in team sports in this age group and teenage boy have a higher level of risk compared with females. Physical factors such as increased muscle mass or higher force of impact can also contribute to the observed differences between genders [29].
To compare the prevalence of signs and symptoms of temporomandibular dysfunction (TMD) in female adolescent athletes and non-athletes and to examine the association between signs and symptoms of TMD in female adolescents in different Tanner stages.
The subjects were 89 female basketball and handball players ages 10–18 years and 72 female non-athlete adolescents ages 10–19 years selected from the Department of Pediatrics (School of Medicine, Federal University of São Paulo) as a control group. A survey was used to assess the signs and symptoms of TMD. According to the answers on the survey the adolescents were classified in two categories: no signs or symptoms present (score A-absent), at least one sign or symptom present (score P-present). The ones who got score “P” were submitted to a standardized functional examination of the masticatory system by four previously calibrated examiners. Pubertal status was assessed based on physical examination by physicians from our Division. The adolescents were classified according to Tanner stages into three subgroups: subgroup 1 (before the growth spurt), subgroup 2 (growth spurt period), subgroup 3 (end of growth spurt). Significant differences between athletes and non-athletes were assessed for categorical variables (Chi-square and Fisher's exact test) and for continuous variables (Mann–Whitney test). The level of significance used was 5%. There was significant agreement between raters, kappa-values (0.621–1.000) and ICC values (0.757–0.899).
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Sporting activities have an inherent risk of facial injury from traumatic impacts from fellow competitors, projectiles, and collisions with posts or the ground. This retrospective review systematically describes the interplay between the type of sport (including the level at which specific sports are played), the sex of the players and their musculoskeletal characteristics, the technology behind the materials used, the protective devices commonly used, the anatomical site, and the regularity of incidence of fractures. We describe how variations in sporting activities induce different orofacial fracture patterns, and critically consider the methods used to test protective headgear against more contemporary techniques. Facial injuries can have a profound psychological effect on those injured, can take a long time to heal, and have been known to end promising careers. Use of properly fitted protective head or facial equipment could reduce the number of facial fractures commonly seen in sports. We recommend that individual sports should have full risk assessments, and that mandatory standards should be agreed about protective devices that would be appropriate.
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To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.
The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson’s chi-square, Bonferroni, Kolmogorov–Smirnov, Kruskal–Wallis and Mann–Whiney tests, and analysis of variance.
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Oral and maxillofacial surgeryMaxillofacial fractures sustained during sports played with a ball

Abstract

Objective

Study design

Results

Conclusions

Introduction

Section snippets

Patients and methods

Results

Yearly and monthly distribution of the fractures

Treatment

Discussion

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Brit J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Brit J Oral Maxillofac Surg

J Cranio-Max-Fac Surg

Brit J Oral Maxillofac Surg

Soccer-related craniomaxillofacial injuries

J Cranifac Surg

Oral and maxillofacial surgery
Maxillofacial fractures sustained during sports played with a ball