Maxillofacial trauma and Psychological Stress

By , 2018-05-31

psychological stress

Maxillofacial trauma, the hard and/or soft trauma to the maxillofacial region, may involve fracture of dental tissue, the mandible 1, 2, 3, 4 zygomatic bone 1, 2, 3, 4 maxilla 1, 2, 3, 4 nasal 1, 2 and frontal bone 1, 2, 3 There may also be concomitant abrasion 5, 6, 7 laceration 5, 6, 7, 8 or contusion of soft tissues 5, 6, 7. It is often a painful experience in body and soul, given that it could easily be a life and death experience from sports 1, 9 falls 1, 5, 9, 10 physical contact 1 violence 10 to road traffic accidents 1, 5.

Treatment for maxillofacial trauma may vary from simple observation 11 to splinting 2, 9 wiring 2, 9, 11 extractions 9, or open 8, 9, 11 closed reduction 8, 11 with/ without internal fixation with bone plates 8, 9, 11. Each stage of management from the initial presentation, treatment and rehabilitation and recovery and follow-up may all post severe blows to the already traumatized patient. Such patients may be faced not only with aesthetic 20 but also functional issues 16, 20.

Single or multiple surgical interventions may be necessary. Eventual healing and rehabilitation could feel forlorn with uncertain outcome. On top of all these, other boggling issues include financial ability 13 social aspect 12 employment issues 12, 13 and underlying medical issues 13 etc. A lot of such trauma patients tend to be associated with increased social anxiety and avoidance 14, 15 depression 14, 15 low self-concept 12, 16 problems with relationships 12 and difficulties withemployment 15. All these does appear to negatively impact on the quality of life of such patients 16, 17, 18.

Often, cultural acceptance 12 and social support 17 plays an important role in the psychological wellbeing of such patients 12, 19. Consequently, it is not difficult to imagine that patients suffering from maxillofacial trauma could have adjustment and adaptation issues stemming from both the trauma and treatment for the trauma 13. Some such patients may have to come to terms with change in appearance 12, 18 aesthetics 12 and functional issues 13, 14, 16 that may correlate more to the subjective severity of either the surgical operation or outcome 14, 15, 19, 20.

It had been reported that the degree of anxiety in patients was directly proportional to the magnitude of injury and the resulting scar 18. There has been technological advances to avoid scars 2, 11. On the other hand, it has been reported that approximately 20% – 40% of patients suffering from maxillofacial trauma may still develop post-traumatic stress disorder 13, 14, 15, 20. Islam et al’s study 20 has shown a nine-fold increase in the risk of depression (odds ratio of 9.02) and a two-fold increase in anxiety disorder (odds ratio or 2.68) in participants with facial trauma. Similar results were obtained in Gandjalikhan-Nassab et al’s 2016 study 18.

One resulting concern for the healthcare team is that psychological stress of patients may potentially complicate recovery and adversely affect patient compliance 20. As such, assessment and provision of psycho-emotional support to patients suffering from maxillofacial trauma, an area less studied, has been gaining interest and importance and protocols put forward 12, 13, 18, 19.

1.Estrela C, Scartezini G R, Guedes O A, AHG de Alencar, CR de Araujo Estrela. (2016) Maxillofacial trauma in a public hospital in Central Brazil: A retrospective study of 405 patients. , Journal of Dental Science 31(4), 153-157.

2.Ahmed A, Ahmed W, SGA Bukhari, Janjua O S, Luqman U et al. (2012) The maxillofacial trauma management trends at Armed Forces Institute of Dentistry,Rawalpindi. Pakistan Oral and Dental. , Journal 32(2), 191-195.

3.Ruslin M, Wolff J, Boffano P, Brand H S, Forouzanfar T. (2015) Dental trauma in association with maxillofacial fractures: an epidemiological study. Dental Traumatology. 31, 318-323.

4.Shaikh M I, Rajput F, Khatoon S, Usman G. (2014) Etiology and incidence of maxillofacial skeletal injuries at tertiary care hospital,Larkana,Pakistan.Pakistan Oral &. , Dent J 34(2), 239-241.

5.SJS Bajwa, Kaur J, Singh A, Kapoor V, Bindra G S et al. (2012) Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute. , National J Maxillofac Surg 3(2), 133-138.

6.Channar K A, Memon A B, Shaikh I A, Punjabi S K, Shumaila. (2016) Pattern and causes of maxillofacial trauma among senior citizens. Pakistan Oral and Dental Journal. 36(3), 372-374.

7.Ferreira M C, Batista A M, F O, Ramos-Jorge M L, Marques L S. (2014) Pattern of oral-maxillofacial trauma stemming from interpersonal physical violence and determinant factors. Dental Traumatology. 30, 15-21.

8.Jung T K, De Silva HL, Konthasingha P P, Tong D C. (2015) Trends in paediatric maxillofacial trauma presenting to Dunedin Hospital,2006to2012. New Zealand Dent. , J 111(2), 76-79.

9.Grover D, Aggarwal A, Sharma P. (2011) Pediatric maxillofacial trauma. , Indian J Stomatol 2(2), 80-85.

10.Al-Qamachi L H, Laverick S, Jones D C. (2012) A clinico-demographic analysis of maxillofacial trauma in the elderly. , Gerodontology 29, 147-149.

11.Ul Haq E, Liaquat A, Aftab A, Mehmood H S. (2014) Etiology, pattern and management of maxillofacial fractures in patients seen at Mayo Hospital, Lahore – Pakistan. Pakistan Oral and Dental Journal. 34(3), 417-421.

12.Bradbury E. (2012) Meeting the psychological needs of patients with facial disfigurement. , British J of Oral and Maxillofac Surg 50, 193-196.


13.A De Sousa. (2008) Psychological issues in oral and maxillofacial reconstructive surgery. , British Journal of Oral and Maxillofacial Surgery 46, 661-664.

14.Islam S, Cole J L, Walton G M, Dinan T G, Hoffman G R. (2012) Psychiatric outcomes in operatively compared with non-operatively managed patients with facial trauma: Is there a difference? J Plast Surg Hand Surg. 46, 399-403.

15.Islam S, Ahmed M, Walton G, Dinan T G, Hoffman G R. (2012) The prevalence of psychological distress in a sample of facial trauma victims. A comparative cross-sectional study between UK and Australia. J Cranio-Maxillo-Facial Surg. 40, 82-85.

16.Ukpong E I, Ugboko Ndukwe KC, Gbolahan O O. (2008) Health-related quality of life in Nigerian patients with facial trauma and controls: a preliminary survey. , British J Oral Maxillofac Surg 46, 297-300.

17.Arhakis A, Athanasiadou E, Vlachou C. (2017) Social and psychological aspects of dental trauma, behavior management of young patients who have suffered dental trauma. The Open Dentistry Journal. 11, 41-47.

18.S-A-H Gandjalikhan-Nassab, Samieirad S, Vakil-Zadeh M, Habib-Aghahi R, Alsadat-Hashemipour M. (2016) Depression and anxiety disorders in a sample of facial trauma: A study from Iran. Med Oral Patol Oral Cir Bucal. 21(4), 477-482.

19.Glynn S M, Asarnow J R, Asarnow R, Shetty V, Elliot-Brown K et al. (2003) The development of acute post-traumatic stress disorder after orofacial injury: A prospective study in a large urban hospital. J Oral Maxillofac Surg. 61, 785-792.

20.Islam S, Ahmed M, Walton G M, Dinan T G, Hoffman G R. (2010) The association between depression and anxiety disorders following facial trauma – A comparative study. , Injury Int J Care Injured 41, 92-96.





影片內”我們” 或 “示範中的方法” 指牙醫業內一般做法或其中一種做法



所有牙醫均可進行公共口腔衛生教育,而公共衛生(Public Health )或社會牙醫科(Community Dentistry )更是牙科內的一個科目。


香港牙醫管理委員會 香港牙醫專業守則

1.6 牙科/口腔健康教育活動

1.6.1 牙醫可以參與真確的牙科/口腔健康教育活動,例如演講及作 專業發表…………..

1.6.3 向公眾提供的資料應具權威性、合宜並與一般經驗相符。該等資料應有事實根據、清楚易明及用詞淺白。


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正確使用氨素,氟素以外牙紋防蛀劑填補牙紋縫隙,牙齒重疊最需要徹底清潔,牙齒磨損,對牙菌膜的監測,簡介牙髓的各種測試,淺談口腔以外的牙科X光,口腔以內的牙科X光,牙髓死亡,淺析咬合垂直距離,牙痛, 到底哪裡痛,能不能忍一時之痛,空姐, 活動假牙托下不應有壞牙腳,氟斑齒的處理方法,注意有否刷蝕牙齒,牙齒消炎丸到底是甚麼.,楊幽幽, 正確使用抗生素,箍牙會唔會失敗, 處理接近神經線的阻生智慧齒,脫牙流血不止,正確清潔牙齒及牙肉邊緣,牙科手術儀器的消毒程序,牙科用具其他消毒程序,黏液囊腫,看見和看不見的蛀牙切除部分牙腳手術,切除部分牙腳手術 2,如何清潔牙腳分岔位 上,如何清潔牙腳分岔位 下,牙線功能成疑,透明牙箍, 美白牙膏去牙漬,洗牙真的很痛嗎,清刮牙腳,再談清刮牙腳,箍牙會唔會失敗, 洗牙流血只因牙肉發炎,口腔腫塊–牙齦瘤,口腔腫塊–乳突瘤,口腔內的黑色素—牙齦的黑色素沉澱,G6PD缺乏症與牙科治療,頭頸癌放化治後牙科問題,關愛基金改善政策使長者更受惠,關愛基金改善政策使長者更受惠, 甩牙,削牙,牙罅,攝牙罅,崩牙,撞崩牙,撞崩棚牙,乸牙,蝕牙,爆牙,吉牙肉,頂牙肉,刮損牙肉,刮牙肉穿窿,哨牙,凹左,凹牙牙肉凸起

腫哂一點點,黑點,咬親,甩左,坐係度都痛污糟,梗住,撼親,口臭,起水泡,整損,損左,撞親,鑽牙,爛牙,箍牙會唔會失敗, 壞牙,疊牙,畸形,畸形牙,唔夠白,偏黃,牙唔齊,兔仔牙,裂開,條脷,刮親條脷,隻牙好鬆,就黎甩,剝牙,自己甩出黎,嵌塞 牙縫刷 腎病 致命牙齒脫位 膿 退縮 戒煙, 箍牙, 骨質疏鬆 腫脹 四環素染色 楊幽幽牙科醫生 更薄的牙齒 刮舌板 牙齒長出 牙齒不可逆性牙髓炎 水氟化, 透明牙箍, X光對生育期內婦女的影響, 什麼年紀最適合箍牙, 假牙, 傷口處理, 公共衛生教育, 剝牙, 副作用, 口腔種植, 成人矯齒成效如何, 止血, 正確刷牙及使用牙線方法, 楊幽幽牙科醫生口腔教育系列 注意事項, 洗牙流血點解, 活動假牙托, 流血不止, 滿口牙套可以箍牙嗎, 漂牙, 牙周病, 牙周病患者是否可以箍牙. 透明牙箍有用嗎, 牙柱, 牙橋, 牙痛, 牙瘡, 牙肉流血, 牙醫, 牙骹, 種牙, 空姐接觸的宇宙射線會否影響胎兒, 笑容, 箍牙會唔會失敗, 脫牙, 蛀牙, 關節 好唔好



楊幽幽 牙科醫生
Dr. Cecilia Young Yau Yau

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