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}.

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