Journal of Health and Medical Sciences

Maxillofacial trauma is defined by the structures located between the capillary line upward and the tip of the chin downward. Our study is retrospective, covering 112 cases of extensive facial fractures over a period of two years from October 2016 to October 2018. Soft tissue lesions are excluded from our study. The goal is to define the epidemiological profile of facial fracture victims in Oujda and to adapt therapeutic modalities to local contexts. The incidence was highest in the 21 to 30 age group (36.6%). There were 7.6 men for a woman. The most common etiologies were in descending order; traffic accidents (60%), assaults (29%), sports accidents (6%). The frequency of these traumas increased in summer, especially in July-August. Mandible and nasal bone were the most affected (48.21% and 21.42%). In 16.96% of cases, it was a polytrauma. Head trauma was associated in 7.14% of cases.


Introduction
Maxillofacial trauma represents a big part of the activity at the ENT and maxillofacial surgery department of Mohammed VI University Hospital.Therefore, specific preventive measures and treatment regimens adapted to the national epidemiological particularities are essential for the management of facial fractures.There has been no previous epidemiological study on facial fractures in Oujda.The purpose of this study was to describe the epidemiological characteristics of maxillofacial fractures our town.

Material & methods
This is a retrospective epidemiological study over a two year period from October 2016 to October 2018, for which we have treated all the files of patients with maxillofacial trauma.112 cases were recorded of patients

Accident de sport
Agression AVP treated at our department.A sheet was prepared for each patient and the following information was recorded: sex, age, date of trauma, etiology, fracture site and clinical aspects.

Results
The average age of our patients was 29 years old.The sex ratio was 6.7 / 1 with male predominance in all age groups (figure 1).The peak frequency of fractures was between 20 and 30 years old in both sexes.August and July are in order of frequency the busiest in terms of maxillofacial trauma, with respectively: 18 and 15 patients (figure2) Figure 1.Age according to gender Figure 2. Monthly distribution The etiologies of facial fractures in our study are represented by traffic accidents with 60% of cases, assaults totaling 29%, the remaining 11% of cases include sports accidents, work accidents, home accidents and other various etiologies.57% of traffic accidents involved a two-wheeled vehicle (motorized or not) (figure3).
Traffic accidents were the leading cause of fractures in age groups above 10 years old, while between ages one and ten, home accidents were the most common (figure 4).
Pain and ecchymosis/edema were the main complaints (figure 5).Fractures were associated with facial wounds in 39% of cases, divided according to facial areas in the figure (figure 6).

Work place 2%
other 3% Associated lesions were essentially skull trauma with 7.14% of fractures and lower limbs 5.35% (Table 1).Fiftyfour patients (48.21%) suffered mandibular fractures.In 54.6% of cases, the lesion affected the middle third of the face and in 2.67% the upper third (Table 2).The dominant mandibular fractures are angular fractures at 42.3% (figure 7).The angular and parasymphyseal fractures are the most common association (table 3).The dominant etiology for mandibular fractures is (figure8).

Discussion
The epidemiological profile of maxillofacial trauma in the region of Oujda is that of a Muslim country heading towards westernization.The significant amount of traffic accidents makes it necessary to undertake a serious public health reflection and a political effort aiming to its prevention.The trauma's epidemiological profile varies according to demographics, cultural habits, industrial environment, transports, political climate, country's legislation (especially concerning road safety ever since Morocco adopted the new Highway Code) and hospital recruitment.The population of our study is very much representative of the general Moroccan people, due to the largely rural and urban recruitment in our department.
Facial fractures affect mainly the young male (30 years old on average).This is explained by risky behaviors during sports practice, motorcycling, driving and violent altercations [Gassner et al. .2001].In Japan [Iida et al., .2001][Iida et al. 2002], the dominant age group is between the ages of ten and twenty.While in Tunisia, the dominant age group was similar to our study ( 20 to 30 years old).As for sex ratio, it largely varies in the literature.Our sex ratio (6,7/1), is at the upper limit with a female minority.Polish, Marrakchi and Tunisian series come close behind [Bouguila et al. 2008] [Qachab et al. 2011].On the other hand, the sex ratio in Italy approaches equality (1.81/1) [Bonavolonta et al. .2017].Summer holidays encourage people to do more activities and road trips.This makes it the busiest period in most studies.
The etiologies of facial trauma are completely correlated to the geographic and socioeconomic context of the country.In countries like Morocco [Qachab et al. .2011It is almost unanimous in the literature that the mandibular fracture is by far the most common facial fracture [Brasileiro et al. 2006][Bouguila et al. 2008][Parluska et al. 2006].It is the first facial bone to hit the ground is case of a fall.The most common forms of bifocal mandibular fractures according to [Gola et al. 1994], are the parasymphyseal fractures associated with contralateral angular or contralateral condylar fractures.These results are consistent with the results of our series.

Table 3 .
Bifocal mandibular fractures [LeBeau et al. 2006015]][Bouguila et al. 2008d Brazil, Traffic accidents are the main cause of facial trauma[Brasileiro et al. 2006][Bouguila et al. 2008].In the meantime, countries with an old population prone to home accidents and very disciplined drivers like Canada[Al Dajani et al. 2015]have home accidents as the first cause of facial fractures.In other regions like the French Alps, ski accidents are the main cause[LeBeau et al. 2006].