Editorial | Open Access
Maxillofacial Trauma and 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.