Traffic accidents are one of the most common causes of morbidity and mortality worldwide, especially in the productive ages. Injuries-fractures of the visceral skull are quite common as a result of a traffic accident. The positive impact of the use of seatbelts and helmets in reducing mortality and morbidity in drivers and passengers of cars and motorcycles, respectively, is well known and obvious. The main purpose and object of this study was the correlation between the severity of fractures of the visceral skull in patients who suffered a traffic accident and the use of seatbelts and helmets. A secondary goal was the correlation between the grade of rehabilitation of visceral skull fractures and the use of seatbelts and helmets. The skull is divided into the cerebral and the visceral skull. The bones of the visceral skull include: nasal bones, maxillas, palatine bones, zygomatic bones, mandible, inferior nasal conchaes, vomer, lacrimal bones. The frontal bone, although involved in the formation of the face, belongs to the bones of the cerebral skull. Although the ethmoid bone is involved in the formation of the median orbital wall and the paranasal sinuses, it is considered by many to belong to the bones of the cerebral skull. In this study, the following types of fractures of the visceral skull were assessed according to their location: fractures of the nasal bones and bony nasal pyramid, naso-orbitalethmoid (NOE) fractures, fractures of the zygomatic complex, fractures of the maxillary bone (walls of maxillary sinus, dentoalvelar), mandibular fractures (symphysis / parasymphysis, body, angle, ramus, condylar / subcondylar, coronoidprocess, dentoalveolar), Le Fort fractures (I, II, III, bilateral or unilateral, combined or not), temporomandibular fractures, panfacial fractures. The study involved 120 patients who suffered fractures of the visceral skull after a traffic accident as drivers or passengers of cars or motorcycles and were treated in fully or partially at the University General Hospital of Ioannina from 2015 to 2019. These were 92 men and 28 women. The initial parameters collected, measured and related to the patient and the accident were: age, sex / gender, date of the accident, type of vehicle (car or motorcycle), role / position of the patient in the vehicle (driver or passenger), use or nonuse of safety device (seatbelt or helmet), alcohol effect. The severity of visceral skull fractures was categorized into three severity grades: mild, moderate, high. Mild severity fractures of the visceral skull included: fractures of the bony nasal pyramid, fractures of the walls of the maxillary sinus (except the roof), fractures of the maxillary alveolar processes, mandibular fractures (not including condyle or coronoid process), condylar fractures (without coexisting another fracture in the mandible), fractures of the coronoid process (without coexisting another fracture in the mandible). Moderate severity fractures of the visceral skull included: mandibular fractures involving the condyle or coronoid process and one or more of its other parts (including the possible combination of condylar fractures and fractures of coronoid process), pure fractures of the orbital floor (blow-out & blow-in), zygomatic complex fractures, Le Fort I fractures (including semi-Le Fort I). The coexistence of 2 or more fractures from the following categories was also classified in this grade of severity: fractures of the bony nasal pyramid, fractures of the walls of the maxillary sinus (except the roof), fractures of the maxillary alveolar processes, mandibular fractures. High severity fractures of the visceral skull included: naso-orbital-ethmoid fractures, Le Fort II fractures (including semi-Le Fort II), Le Fort III fractures (including semi-Le Fort III), combined Le Fort fractures, panfacial fractures. Additionally, the parameter of average or total grade of severity of fractures of the visceral skull for each group of patients was created and was equal to the sum of the severity grades for each patient in the group separately by the number of patients in this group. For reasons of completeness, the presence or absence of concomitant injuries in areas other than the visceral skull was also assessed. With regard to the treatment of fractures of the visceral skull, the following parameters were assessed and measured: surgical treatment (presence or absence), date of first or unique surgery, time in days between traffic accident and first or unique surgery, post-operative days of hospitalization, one or more revision surgeries (presence or absence). To assess the grade of rehabilitation of fractures of the visceral skull, criteria were created which could be measured (presence or absence) before and after possible treatment and were as follows: mandibular mobility disorder, maxillary mobilitydisorder (or paradoxical mobility), dental occlusion disorder (malocclusion), cosmetic disorder (strictly due to fractures of the visceral skull). The grade of rehabilitation for each criterion separately could take the following values: complete, partial / none. The overall grade of rehabilitation of fractures of the visceral skull could take one of the following values: complete, partial, none. The results of this study were divided into two categories: drivers and passengers of cars, drivers and passengers of motorcycles. Regarding the group of drivers andpassengers of cars, the following were the main conclusions: The absence of seatbelt use is associated with an increase in the grade ofseverity of fractures of the visceral skull, a relationship that was statistically significant (p<0.05). The absence of seatbelt use is associated with an increased need for surgical treatment of visceral skull fractures, a statistically significant relationship (p<0.05). Additionally, the absence of seatbelt use is associated with an increased need for 2 or more surgeries to treat visceral skull fractures, but this relationship was not statistically significant (p>0.05). The presence of seatbelt use is associated with a higher grade of rehabilitation of visceral skull fractures, but this relationship that was not statistically significant (p>0.05). Regarding the group of drivers and passengers of motorcycles, the following were the main conclusions: The absence of helmet use is associated with an increase in the grade of severity of fractures of the visceral skull, a relationship that was statistically significant (p<0.05). The absence of helmet use is associated with an increased need for surgical treatment of visceral skull fractures, a statistically significant relationship (p<0.05). Additionally, the absence of helmet use is associated with an increased need for 2 or more surgeries to treat visceral skull fractures, but this relationship was not statistically significant (p>0.05). The presence of helmet use is associated with a higher grade of rehabilitation of visceral skull fractures, but this relationship was not statistically significant (p>0.05). The results of our study demonstrate the value of using seatbelt and helmet inpreventing and reducing the morbidity of patients who have been involved in a traffic accident, especially in terms of visceral skull fractures. We hope future studies to be conducted with similar goals, which will probably overcome possible weaknesses of our study and with their conclusions will once again confirm the value of the use of seatbelts and helmets by drivers and passengers of cars and motorcycles respectively further consolidating their use.
National Documentation Centre (EKT)
