Epidemiology of maxillofacial injuries during monsoon and non-monsoon season in India: a data-based retrospective study from a tertiary care dental teaching hospital

Anand Deep Shukla; Srikanth G; Kalyan Chakravarthy; Ayusha Kaushal; Hariti M Udeshi

doi:10.12688/f1000research.134532.1

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Research Article

Epidemiology of maxillofacial injuries during monsoon and non-monsoon season in India: a data-based retrospective study from a tertiary care dental teaching hospital

[version 1; peer review: 1 approved, 1 approved with reservations]

Anand Deep Shukla¹, Srikanth G¹, Kalyan Chakravarthy², Ayusha Kaushal¹, Hariti M Udeshi¹

Anand Deep Shukla¹, Srikanth G¹, [...] Kalyan Chakravarthy², Ayusha Kaushal¹, Hariti M Udeshi¹

PUBLISHED 19 Oct 2023

Author details Author details

¹ Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
² Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India

Anand Deep Shukla
Roles: Conceptualization, Methodology, Resources, Software, Validation, Writing – Review & Editing

Srikanth G
Roles: Conceptualization, Data Curation, Methodology, Resources, Validation, Writing – Original Draft Preparation

Kalyan Chakravarthy
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Ayusha Kaushal
Roles: Conceptualization, Investigation, Methodology, Resources, Writing – Original Draft Preparation

Hariti M Udeshi
Roles: Conceptualization, Investigation, Methodology, Resources, Supervision, Writing – Original Draft Preparation

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Manipal Academy of Higher Education gateway.

Abstract

Background: Maxillofacial Injury (MFI) is a major public health concern that is multifactorial in etiology-road traffic accidents (RTAs), falls and violence. RTAs are the major cause of maxillofacial injuries (MFIs) in countries like India. Recent studies have shown that maxillofacial fractures (MFF) constitute a significant proportion of facial injuries seen in hospitals (56.5%). The incidence of maxillofacial fractures can vary depending on several factors, including age, gender, and environmental factors. Of particular concern is the impact of seasonal variations, such as the monsoon season, which lead to high incidence of maxillofacial fractures due to hazardous conditions.
Methods: A retrospective review of medical records was done in a tertiary-care dental teaching hospital was done.
Results: Data of 200 subjects including 154 males (77%) and 46 females (23%) with a mean age of 35.38 ± 16.541 years; age range: 1 – 80 years was analyzed. A total of 200 MFI’s were recorded between 2021 and 2022. Soft tissue injuries were reported in 37.5% of the cases in non-monsoon season and 42.3% of the cases during the monsoon season. Dentoalveolar fractures were reported in 6.2% of the cases during the non-monsoon seasons and 7.7% during the monsoon season. In this study, mandible was the most fractured bone (n=104,52%) followed by zygomatic complex (n=50, 25%). The frequently observed pattern among mandibular fracture was condyle 8.3% during the non-monsoon season and 2.9% during the monsoon season).
Conclusions: The results of the study indicate that mandibular fractures are most commonly seen in maxillofacial fractures, followed by fractures of the zygomatic complex. The study also reveals a higher incidence of soft tissue injuries and dentoalveolar fractures during the monsoon season. Further research is warranted to explore the factors that contribute to the seasonal variation in maxillofacial fractures for effective interventions to reduce their occurrence.

Keywords

Maxillofacial injuries, Road Traffic Accidents

Corresponding author: Srikanth G

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Shukla AD et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Shukla AD, G S, Chakravarthy K et al. Epidemiology of maxillofacial injuries during monsoon and non-monsoon season in India: a data-based retrospective study from a tertiary care dental teaching hospital [version 1; peer review: 1 approved, 1 approved with reservations]. F1000Research 2023, 12:1377 (https://doi.org/10.12688/f1000research.134532.1) First published: 19 Oct 2023, 12:1377 (https://doi.org/10.12688/f1000research.134532.1) Latest published: 04 Mar 2024, 12:1377 (https://doi.org/10.12688/f1000research.134532.2)

Introduction

Maxillofacial injury (MFI) is a broad term used to describe any form of damage or trauma to the structures of the face, including the jaw, teeth, and facial bones and associated soft tissues.¹ Maxillofacial fractures (MFF), on the other hand, specifically refer to fractures or breaks in one or more of the facial bones, such as the mandible or zygomatic complex. It is important to note that while MFFs are a type of MFI, not all MFIs involve fractures.

MFIs are a significant public health concern, with a wide spectrum of severity that can range from minor injuries to life-threatening conditions.² The incidence of maxillofacial fractures can vary depending on several factors, including age, gender, and environmental factors.

Recent studies have demonstrated that maxillofacial fractures are among the most frequent types of facial injuries seen in hospitals 56.5%.³^,⁴ These fractures can involve different components of the facial skeleton, including the mandible, maxilla, zygoma, and orbital bones.³^,⁴

Additionally, it is important to consider how environmental factors may affect the number of maxillofacial fractures in hospital settings. The monsoon season, for example, may result in an increase in maxillofacial fractures owing to slippery roads and pavements, reduced visibility, and fallen trees and electrical wires.

Healthcare providers must be aware of these trends and take steps to predict and manage maxillofacial injuries. Therefore, this research paper aims to compare the incidence and pattern of maxillofacial trauma in a hospital-based setting with a focus on environmental factors.

Methods

Study design

The present study was conducted in the Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Manipal, Udupi, Karnataka, India. This study was based on a systematic computer-assisted database search that allowed extraction of retrospective data of the patients who reported to our outpatient unit with injuries from RTA from December 2021 to December 2022.

Data collection was initiated only after requisite approvals were obtained from the Scientific Committee and the Institutional Ethics Committee of Hospital (IEC:57/2022).

The requirement for informed consent was waived in view of the retrospective nature of the study and there being no direct contact with the study subjects. This study did not involve any intervention or therapy, and the research involved no risks to the subjects. Subjects’ names and identity were not disclosed in any way during or after this database review study. Subjects were identified by subject ID numbers only, and hence, patient data confidentiality has been maintained.

Subject screening, inclusion and exclusion criteria

Patients of both sexes and all age groups with clinically and radiographically diagnosed maxillofacial fractures (with or without contiguous bodily fractures/injuries) were included in this study. Patients with incomplete records were excluded from the study. Patients with isolated skull fractures and only minor superficial soft tissue injuries were excluded from our study.

No formal sample size was calculated and all 200 patients who met the inclusion criteria during the study period were included.

Data collection

The hospital records were assessed and data on age, sex and season during which injury occurred was collected. Data was also recorded for anatomic location of facial fractures, associated soft tissue and dentoalveolar injury. In records fractures had been classified as fractures of the mandible, zygomatic-maxillary complex (OZMC), orbital floor, nose, Lefort I,II,III and naso-orbital-ethmoid (NOE) fracture. Mandibular fractures included fractures of the symphysis, Para symphysis, body, angle, ramus, coronoid, and condyle (Tables 3 and 4).

Statistical analysis

Statistical analysis was performed using SPSS-20.0 for the Windows Statistical Package (IBM Corporation, Armonk, NY, USA) and a p value of ≤0.05 was considered statistically significant.

Descriptive data were presented as mean ± SD or number (%), unless specified. Univariate analysis was done by Student’s t-test. Data for incidence of soft tissue injuries, dentoalveolar Injuries and various facial fractures were compared between the two seasons i.e., monsoon and non-monsoon.

Results

In one year, period between December 2021 to December 2022, data of a total of 200 subjects were recorded and analyzed. Out of these, 154 (77%) were males while only 47 (23%) were females (Table 2). Male to female ratio was 3.28:1 (rounded to two decimal places) (Figure 1). The mean age of study population was 35.38 ± 16.541 years (age range: 1-80 years) (Table 1).

Figure 1. Pie chart showing the sex distribution of the studied maxillofacial trauma cases.

Table 1. Mean age of distribution.

	N	Minimum	Maximum	Mean	Std. Deviation
Age	200	1	80	35.38	16.541

Table 2. Sex distribution.

		Frequency	Percent
Sex	F	46	23.0
Sex	M	154	77.0

Table 3. Distribution of maxillofacial fractures in Monsoon and Non-monsoon seasons.

	Non-monsoon season		Monsoon season		P-value
	N	%	N	%	P-value
Soft Tissue Injury
Absent	60	62.5%	60	57.7%	0.488
Present	36	37.5%	44	42.3%
Dentoalveolar Injury
Absent	90	93.8%	96	92.3%	0.69
Present	6	6.2%	8	7.7%

Table 4. Distribution of various types of fractures in Monsoon and Non-monsoon season.

		Monsoon				P-value
		0		1
		N	%	N	%
SOFT TISSUE INJURY	0	60	62.5%	60	57.7%	0.488
SOFT TISSUE INJURY	1	36	37.5%	44	42.3%
DENTOALVEOLAR	0	90	93.8%	96	92.3%	0.69
DENTOALVEOLAR	1	6	6.2%	8	7.7%
LEFORT I	0	95	99.0%	100	96.2%	0.371
LEFORT I	1	1	1.0%	4	3.8%
LEFORT II	0	96	100.0%	103	99.0%	>0.99
LEFORT II	1	0	0.0%	1	1.0%
LEFORT III	0	92	95.8%	99	95.2%	>0.99
LEFORT III	1	4	4.2%	5	4.8%
FRONTAL BONE	0	87	90.6%	101	97.1%	0.053; Sig
FRONTAL BONE	1	9	9.4%	3	2.9%
PALATAL BONE	0	93	96.9%	103	99.0%	0.352
PALATAL BONE	1	3	3.1%	1	1.0%
TEMPORAL BONE	0	92	95.8%	103	99.0%	0.147
TEMPORAL BONE	1	4	4.2%	1	1.0%
ZYGOMATIC ARCH	0	72	75.0%	98	94.2%	<0.001; Sig
ZYGOMATIC ARCH	1	24	25.0%	6	5.8%
NOE	0	95	99.0%	102	98.1%	>0.99
NOE	1	1	1.0%	2	1.9%
FZ	0	93	96.9%	104	100.0%	0.109
FZ	1	3	3.1%	0	0.0%
PYRIFORM	0	94	97.9%	102	98.1%	>0.99
PYRIFORM	1	2	2.1%	2	1.9%
ZMC	0	61	63.5%	87	83.7%	0.001; Sig
ZMC	1	35	36.5%	17	16.3%
ORBITAL RIM	0	89	92.7%	104	100.0%	0.005; Sig
ORBITAL RIM	1	7	7.3%	0	0.0%
ORBITAL FLOOR	0	73	76.0%	92	88.5%	0.021
ORBITAL FLOOR	1	23	24.0%	12	11.5%
ORBITAL WALL	0	94	97.9%	103	99.0%	0.609
ORBITAL WALL	1	2	2.1%	1	1.0%
SPHENOID BONE	0	96	100.0%	103	99.0%	>0.99
SPHENOID BONE	1	0	0.0%	1	1.0%
TYMPANIC PLATE	0	95	99.0%	103	99.0%	>0.99
TYMPANIC PLATE	1	1	1.0%	1	1.0%
NASAL BONE	0	85	88.5%	98	94.2%	0.149
NASAL BONE	1	11	11.5%	6	5.8%
SINUS WALL	0	93	96.9%	104	100.0%	0.109
SINUS WALL	1	3	3.1%	0	0.0%
PTERYGOID PLATE	0	95	99.0%	104	100.0%	0.48
PTERYGOID PLATE	1	1	1.0%	0	0.0%
SYMPHYSIS	0	96	100.0%	101	97.1%	0.247
SYMPHYSIS	1	0	0.0%	3	2.9%
PARASYMPHYSIS	0	94	97.9%	100	96.2%	0.684
PARASYMPHYSIS	1	2	2.1%	4	3.8%
ANGLE	0	94	97.9%	101	97.1%	>0.99
ANGLE	1	2	2.1%	3	2.9%
BODY	0	91	94.8%	99	95.2%	>0.99
BODY	1	5	5.2%	5	4.8%
RAMUS	0	95	99.0%	103	99.0%	>0.99
RAMUS	1	1	1.0%	1	1.0%
CONDYLE	0	88	91.7%	101	97.1%	0.091
CONDYLE	1	8	8.3%	3	2.9%
CORONOID	0	94	97.9%	104	100.0%	0.139
CORONOID	1	2	2.1%	0	0.0%

Discussion

Maxillofacial trauma can be caused by various factors including falls, assaults, sporting injuries and road traffic accidents. Of these, road traffic accidents and monsoon weather conditions have been identified as significant contributors to the incidence of maxillofacial injuries. Given the increasing prevalence of road traffic accidents and unpredictable weather patterns, it is important to understand the epidemiology of maxillofacial injuries and identify any underlying patterns or trends that may exist to help reduce their incidence.

Some regions show a correlation between monsoon season and an increase in facial fractures, possibly due to broken and slippery roads/pavements,⁵^,⁶ falling objects, electrical wires, poor visibility and increased traffic congestion. This can lead to an increase in road traffic accidents and facial injuries. However, there is evidence to suggest that monsoon periods may have fewer cases of facial fractures as people may prefer to stay indoors in anticipation of rain.⁷

Understanding these trends and patterns can help develop preventive measures to improve public safety, especially in areas where monsoons are severe.

The incidence of maxillofacial fractures is higher in developing countries than in developed ones due to several factors such as the lack of adequate safety measures, poor road infrastructure and social factors.⁵^,⁸

The increase in both the frequency and severity of maxillofacial injuries can be linked to the high dependence on road transportation and the growth of socio-economic activities in developing countries. Contributing to these injuries are poor road safety awareness, unsuitable road conditions, underdeveloped motorways, speeding, outdated vehicles without safety features, and a lack of helmets and seat belts, as well as violations of traffic laws.⁵^,⁹ All these factors come together to create a high number of road traffic accidents in developing countries.

Men show higher incidence for MFI’s due to their greater involvement in high-risk activities, outdoor activities, anatomical differences, and behavioral differences such as risk-taking in comparison to women as only few of them drive a vehicle. This has resulted in an increase in the male: female ratio this is found to be consistent with the findings reported in other research papers.⁴^,⁵^,⁸

On analyzing the data, we found that soft tissue injury and dentoalveolar injury are not significantly associated with monsoon season, while zygomatic arch, zygomaticomaxillary complex, frontal, orbital floor and orbital rim fractures are significantly more common during monsoon season.

In this study the incidence of maxillofacial trauma due to RTA during the monsoon season was found to be lesser but the severity of trauma was found to be greater.⁷

Our study was conducted in an environment with better road infrastructure and easy access to immediate medical care, which may have contributed to a lower incidence of maxillofacial trauma. This contrasts with previous studies that have reported a higher incidence of maxillofacial trauma in low-income countries with poor infrastructure and limited access to healthcare services.

Future studies that are planned shall have a database which includes patients over a longer period of time so that the database is much wider.

Data availability

Underlying data

Figshare: Data for the study on epidemiology of maxillofacial trauma, https://doi.org/10.6084/m9.figshare.23558628.v2.¹⁰

- Data updated.xlsx
- data legend.docx

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

1. Kaur G, Singh A, Mahajan A: Maxillofacial Trauma. Indian J. Anaesth. 2003 Jul 1; 47(4): 290–293.
2. Akhlaq M, Ali S, Asghar R, et al.: Pattern and etiology of maxillofacial fractures in Lahore, Pakistan. J. Ayub Med. Coll. Abbottabad. 2014; 26(1): 58–61.
3. Bali RK, Sharma P, Garg A, et al.: A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India. J. Inj. Violence Res. 2013; 5(1): 38–50. Publisher Full Text
4. Boffano P, Kommers SC, Karagozoglu KH, et al.: Aetiology of maxillofacial fractures: a review of published studies during the last 30 years. Br. J. Oral Maxillofac. Surg. 2014; 52(10): 901–906. PubMed Abstract | Publisher Full Text
5. Gurung US, Singh G, Mishra M, et al.: Maxillofacial Injuries Related to Road Traffic Accidents: A Five Year Multi Center Analysis. Craniomaxillofacial Trauma & Reconstruction Open. 2020; 3: s-0039-1694708. Publisher Full Text
6. Agnihotri A, Garg R, Alok A: A study of pattern of maxillofacial trauma in a tertiary care hospital in North India. Natl. J. Maxillofac. Surg. 2011 Jul-Dec; 2(2): 150–154.
7. Johnson AG, Ravindran V, Ravindran Nair KS, et al.: Variation of Incidence of Maxillofacial Trauma due to Road Traffic Accidents during monsoon and non-monsoon period in Malabar region, Kerala, India. Int. J. Curr. Res. 2020; 12(11): 14505–14509.
8. Aleksanyan LV, Poghosyan AY, Misakyan MS, et al.: Epidemiology of maxillofacial injuries in “Heratsi” No 1 university hospital in Yerevan, Armenia: a retrospective study. BMC Oral Health. 2022 Apr 12; 22(1): 123. PubMed Abstract | Publisher Full Text | Free Full Text
9. Khan TU, Rahat S, Khan ZA, et al.: Etiology and pattern of maxillofacial trauma. PLoS One. 2022 Sep 29; 17(9): e0275515. PubMed Abstract | Publisher Full Text | Free Full Text
10. Shukla AD: Data for the study on epidemology of maxillofacial trauma. figshare. [Dataset]. Figshare. 2023. Publisher Full Text

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 19 Oct 2023

Author details Author details

Anand Deep Shukla
Roles: Conceptualization, Methodology, Resources, Software, Validation, Writing – Review & Editing

Srikanth G
Roles: Conceptualization, Data Curation, Methodology, Resources, Validation, Writing – Original Draft Preparation

Kalyan Chakravarthy
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Ayusha Kaushal
Roles: Conceptualization, Investigation, Methodology, Resources, Writing – Original Draft Preparation

Hariti M Udeshi
Roles: Conceptualization, Investigation, Methodology, Resources, Supervision, Writing – Original Draft Preparation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 04 Mar 2024, 12:1377

https://doi.org/10.12688/f1000research.134532.2

version 1

Published: 19 Oct 2023, 12:1377

https://doi.org/10.12688/f1000research.134532.1

© 2023 Shukla AD et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Shukla AD, G S, Chakravarthy K et al. Epidemiology of maxillofacial injuries during monsoon and non-monsoon season in India: a data-based retrospective study from a tertiary care dental teaching hospital [version 1; peer review: 1 approved, 1 approved with reservations]. F1000Research 2023, 12:1377 (https://doi.org/10.12688/f1000research.134532.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

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Reviewer Report 20 Feb 2024

Rui Santos, School of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal; Integrated Researcher at the Statistics and Applications Center of the University of Lisbon, Lisboa, Portugal

Approved with Reservations

https://doi.org/10.5256/f1000research.147594.r243082

The authors present a retrospective study of the etiology and the type of maxillofacial injuries depending on factors such as sex, age and monsoon season in India.

In this study, 200 maxillofacial injuries are analyzed from the medical records of a tertiary-care dental teaching hospital. The critical analysis of the results is interesting, but there are some aspects that should be clarified and/or improved, namely:

- The authors state "Univariate analysis was done by Student’s t-test". What was the t-test used for?

- Tables should be presented (and numbered) in the order in which they are referred to (table 2 is referred to before table 1).

- Figure 1 and Table 2 have the same information (and neither adds information in relation to what is in the text). I think they can be both removed.

- All information in Table 1 is referred to in the text (this table can also be removed).

- All information from Table 3 is included in the first lines of Table 4, so this table must be removed.

- In Table 4, the column headings are clearer if are used in the same way as those in Table 3 (i.e., "Non-monsoon season" and "Monsoon season" instead of 0 and 1). The same occurs in the line designations, where "Absent" and "Present" are clearer than 0 and 1 (even with the explanation in a footnote to the table).

- The results section should be developed in order to clarify the results presented, in particular which p-value is presented in Table 4 (i.e., which test was carried out, as it appears to be a comparison test of the proportions observed between the two seasons, but the only test referred in the text is the univariate t-test which is not suitable for this purpose). Moreover, in Table 4, why is "Sig" (significant) the p-value "0.053" on the "FRONTAL BONE", but the p-value "0.021" is not significant in the "ORBITAL FLOOR"?

- Some discussion and references are related to the etiology of maxillofacial injuries, such as road traffic accidents, falls, assaults, sports injuries, and violence. Moreover, it is stated that "In this study the incidence of maxillofacial trauma due to RTA during the monsoon season was found to be lesser but the severity of trauma was found to be greater". Can the authors provide the data (for example in a table) on which they based this statement? In fact, in the Results section nothing is presented about the etiology of the maxillofacial injuries. If the analyzed data contains information about the etiology, it would be relevant to include this information in summary form in the Results section. Please note that the provided data does not contain any information about the etiology.

- In the discussion, differences in terms of sex are also mentioned ("Men show higher incidence"...). Since the analyzed data contains information about the sex of the patients, what can be concluded from the analysed data? Is it possible to add results (in the Results section) that highlight the differences between the sexes in the maxillofacial injuries?

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Statistical inference, data science, meta-analysis and epidemiology, mainly applied to the areas of Medicine and Forensic Science.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 13 Apr 2024

anand deep shukla, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, 576104, India

13 Apr 2024

Author Response

Thank you for reviewing the manuscript.
Below are the comments raised by the 2nd reviewer along with the replies

Query: The authors state "Univariate analysis was done by Student’s ... Continue reading Thank you for reviewing the manuscript.
Below are the comments raised by the 2nd reviewer along with the replies

Query: The authors state "Univariate analysis was done by Student’s t-test". What was the t-test used for?
Reply : Apologies for the confusion. We have corrected the same. “Data for incidence of soft tissue injuries, dentoalveolar Injuries and various facial fractures were compared between the two seasons i.e., monsoon and non-monsoon using Chi-square or Fishers exact test.”

Query: Tables should be presented (and numbered) in the order in which they are referred to (table 2 is referred to before table 1).
Reply: Tables have been numbered accordingly.

Query: Figure 1 and Table 2 have the same information (and neither adds information in relation to what is in the text). I think they can be both removed.
Reply: Both Figure 1 and Table 2 have been removed.

Query: All information in Table 1 is referred to in the text (this table can also be removed).
Reply: The table has been removed

Query: All information from Table 3 is included in the first lines of Table 4, so this table must be removed.
Reply: The table has been removed

Query: In Table 4, the column headings are clearer if are used in the same way as those in Table 3 (i.e., "Non-monsoon season" and "Monsoon season" instead of 0 and 1). The same occurs in the line designations, where "Absent" and "Present" are clearer than 0 and 1 (even with the explanation in a footnote to the table).
Reply: The column headings are changes to Non monsoon and monsoon season as instructed.

Query: The results section should be developed in order to clarify the results presented, in particular which p-value is presented in Table 4 (i.e., which test was carried out, as it appears to be a comparison test of the proportions observed between the two seasons, but the only test referred in the text is the univariate t-test which is not suitable for this purpose). Moreover, in Table 4, why is "Sig" (significant) the p-value "0.053" on the "FRONTAL BONE", but the p-value "0.021" is not significant in the "ORBITAL FLOOR"?
Reply: The statistical analysis that was carried out was Chi-square or Fishers exact test, the same has been corrected in the manuscript. The p value of 0.021 for orbital floor has been changed to significant as pointed out.

Query: Some discussion and references are related to the etiology of maxillofacial injuries, such as road traffic accidents, falls, assaults, sports injuries, and violence. Moreover, it is stated that "In this study the incidence of maxillofacial trauma due to RTA during the monsoon season was found to be lesser but the severity of trauma was found to be greater". Can the authors provide the data (for example in a table) on which they based this statement? In fact, in the Results section nothing is presented about the etiology of the maxillofacial injuries. If the analyzed data contains information about the etiology, it would be relevant to include this information in summary form in the Results section. Please note that the provided data does not contain any information about the etiology.
Reply: We have omitted the line as per the suggestion.
The included cases were only due to RTA as etiology.

Query: In the discussion, differences in terms of sex are also mentioned ("Men show higher incidence"...). Since the analyzed data contains information about the sex of the patients, what can be concluded from the analyzed data? Is it possible to add results (in the Results section) that highlight the differences between the sexes in the maxillofacial injuries?
Reply: The data highlighting the sex distribution in maxillofacial injuries has been added.
Thank you for reviewing the manuscript.
Below are the comments raised by the 2nd reviewer along with the replies

Query: The authors state "Univariate analysis was done by Student’s t-test". What was the t-test used for?
Reply : Apologies for the confusion. We have corrected the same. “Data for incidence of soft tissue injuries, dentoalveolar Injuries and various facial fractures were compared between the two seasons i.e., monsoon and non-monsoon using Chi-square or Fishers exact test.”

Query: Tables should be presented (and numbered) in the order in which they are referred to (table 2 is referred to before table 1).
Reply: Tables have been numbered accordingly.

Query: Figure 1 and Table 2 have the same information (and neither adds information in relation to what is in the text). I think they can be both removed.
Reply: Both Figure 1 and Table 2 have been removed.

Query: All information in Table 1 is referred to in the text (this table can also be removed).
Reply: The table has been removed

Query: All information from Table 3 is included in the first lines of Table 4, so this table must be removed.
Reply: The table has been removed

Query: In Table 4, the column headings are clearer if are used in the same way as those in Table 3 (i.e., "Non-monsoon season" and "Monsoon season" instead of 0 and 1). The same occurs in the line designations, where "Absent" and "Present" are clearer than 0 and 1 (even with the explanation in a footnote to the table).
Reply: The column headings are changes to Non monsoon and monsoon season as instructed.

Query: The results section should be developed in order to clarify the results presented, in particular which p-value is presented in Table 4 (i.e., which test was carried out, as it appears to be a comparison test of the proportions observed between the two seasons, but the only test referred in the text is the univariate t-test which is not suitable for this purpose). Moreover, in Table 4, why is "Sig" (significant) the p-value "0.053" on the "FRONTAL BONE", but the p-value "0.021" is not significant in the "ORBITAL FLOOR"?
Reply: The statistical analysis that was carried out was Chi-square or Fishers exact test, the same has been corrected in the manuscript. The p value of 0.021 for orbital floor has been changed to significant as pointed out.

Query: Some discussion and references are related to the etiology of maxillofacial injuries, such as road traffic accidents, falls, assaults, sports injuries, and violence. Moreover, it is stated that "In this study the incidence of maxillofacial trauma due to RTA during the monsoon season was found to be lesser but the severity of trauma was found to be greater". Can the authors provide the data (for example in a table) on which they based this statement? In fact, in the Results section nothing is presented about the etiology of the maxillofacial injuries. If the analyzed data contains information about the etiology, it would be relevant to include this information in summary form in the Results section. Please note that the provided data does not contain any information about the etiology.
Reply: We have omitted the line as per the suggestion.
The included cases were only due to RTA as etiology.

Query: In the discussion, differences in terms of sex are also mentioned ("Men show higher incidence"...). Since the analyzed data contains information about the sex of the patients, what can be concluded from the analyzed data? Is it possible to add results (in the Results section) that highlight the differences between the sexes in the maxillofacial injuries?
Reply: The data highlighting the sex distribution in maxillofacial injuries has been added.
Competing Interests: Nil Close
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Author Response 13 Apr 2024

anand deep shukla, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, 576104, India

13 Apr 2024

Author Response

Thank you for reviewing the manuscript.
Below are the comments raised by the 2nd reviewer along with the replies

Query: The authors state "Univariate analysis was done by Student’s ... Continue reading Thank you for reviewing the manuscript.
Below are the comments raised by the 2nd reviewer along with the replies

Query: The authors state "Univariate analysis was done by Student’s t-test". What was the t-test used for?
Reply : Apologies for the confusion. We have corrected the same. “Data for incidence of soft tissue injuries, dentoalveolar Injuries and various facial fractures were compared between the two seasons i.e., monsoon and non-monsoon using Chi-square or Fishers exact test.”

Query: Tables should be presented (and numbered) in the order in which they are referred to (table 2 is referred to before table 1).
Reply: Tables have been numbered accordingly.

Query: Figure 1 and Table 2 have the same information (and neither adds information in relation to what is in the text). I think they can be both removed.
Reply: Both Figure 1 and Table 2 have been removed.

Query: All information in Table 1 is referred to in the text (this table can also be removed).
Reply: The table has been removed

Query: All information from Table 3 is included in the first lines of Table 4, so this table must be removed.
Reply: The table has been removed

Query: In Table 4, the column headings are clearer if are used in the same way as those in Table 3 (i.e., "Non-monsoon season" and "Monsoon season" instead of 0 and 1). The same occurs in the line designations, where "Absent" and "Present" are clearer than 0 and 1 (even with the explanation in a footnote to the table).
Reply: The column headings are changes to Non monsoon and monsoon season as instructed.

Query: The results section should be developed in order to clarify the results presented, in particular which p-value is presented in Table 4 (i.e., which test was carried out, as it appears to be a comparison test of the proportions observed between the two seasons, but the only test referred in the text is the univariate t-test which is not suitable for this purpose). Moreover, in Table 4, why is "Sig" (significant) the p-value "0.053" on the "FRONTAL BONE", but the p-value "0.021" is not significant in the "ORBITAL FLOOR"?
Reply: The statistical analysis that was carried out was Chi-square or Fishers exact test, the same has been corrected in the manuscript. The p value of 0.021 for orbital floor has been changed to significant as pointed out.

Query: Some discussion and references are related to the etiology of maxillofacial injuries, such as road traffic accidents, falls, assaults, sports injuries, and violence. Moreover, it is stated that "In this study the incidence of maxillofacial trauma due to RTA during the monsoon season was found to be lesser but the severity of trauma was found to be greater". Can the authors provide the data (for example in a table) on which they based this statement? In fact, in the Results section nothing is presented about the etiology of the maxillofacial injuries. If the analyzed data contains information about the etiology, it would be relevant to include this information in summary form in the Results section. Please note that the provided data does not contain any information about the etiology.
Reply: We have omitted the line as per the suggestion.
The included cases were only due to RTA as etiology.

Query: In the discussion, differences in terms of sex are also mentioned ("Men show higher incidence"...). Since the analyzed data contains information about the sex of the patients, what can be concluded from the analyzed data? Is it possible to add results (in the Results section) that highlight the differences between the sexes in the maxillofacial injuries?
Reply: The data highlighting the sex distribution in maxillofacial injuries has been added.
Thank you for reviewing the manuscript.
Below are the comments raised by the 2nd reviewer along with the replies

Query: The authors state "Univariate analysis was done by Student’s t-test". What was the t-test used for?
Reply : Apologies for the confusion. We have corrected the same. “Data for incidence of soft tissue injuries, dentoalveolar Injuries and various facial fractures were compared between the two seasons i.e., monsoon and non-monsoon using Chi-square or Fishers exact test.”

Query: Tables should be presented (and numbered) in the order in which they are referred to (table 2 is referred to before table 1).
Reply: Tables have been numbered accordingly.

Query: Figure 1 and Table 2 have the same information (and neither adds information in relation to what is in the text). I think they can be both removed.
Reply: Both Figure 1 and Table 2 have been removed.

Query: All information in Table 1 is referred to in the text (this table can also be removed).
Reply: The table has been removed

Query: All information from Table 3 is included in the first lines of Table 4, so this table must be removed.
Reply: The table has been removed

Query: In Table 4, the column headings are clearer if are used in the same way as those in Table 3 (i.e., "Non-monsoon season" and "Monsoon season" instead of 0 and 1). The same occurs in the line designations, where "Absent" and "Present" are clearer than 0 and 1 (even with the explanation in a footnote to the table).
Reply: The column headings are changes to Non monsoon and monsoon season as instructed.

Query: The results section should be developed in order to clarify the results presented, in particular which p-value is presented in Table 4 (i.e., which test was carried out, as it appears to be a comparison test of the proportions observed between the two seasons, but the only test referred in the text is the univariate t-test which is not suitable for this purpose). Moreover, in Table 4, why is "Sig" (significant) the p-value "0.053" on the "FRONTAL BONE", but the p-value "0.021" is not significant in the "ORBITAL FLOOR"?
Reply: The statistical analysis that was carried out was Chi-square or Fishers exact test, the same has been corrected in the manuscript. The p value of 0.021 for orbital floor has been changed to significant as pointed out.

Query: Some discussion and references are related to the etiology of maxillofacial injuries, such as road traffic accidents, falls, assaults, sports injuries, and violence. Moreover, it is stated that "In this study the incidence of maxillofacial trauma due to RTA during the monsoon season was found to be lesser but the severity of trauma was found to be greater". Can the authors provide the data (for example in a table) on which they based this statement? In fact, in the Results section nothing is presented about the etiology of the maxillofacial injuries. If the analyzed data contains information about the etiology, it would be relevant to include this information in summary form in the Results section. Please note that the provided data does not contain any information about the etiology.
Reply: We have omitted the line as per the suggestion.
The included cases were only due to RTA as etiology.

Query: In the discussion, differences in terms of sex are also mentioned ("Men show higher incidence"...). Since the analyzed data contains information about the sex of the patients, what can be concluded from the analyzed data? Is it possible to add results (in the Results section) that highlight the differences between the sexes in the maxillofacial injuries?
Reply: The data highlighting the sex distribution in maxillofacial injuries has been added.
Competing Interests: Nil Close
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Reviewer Report 31 Oct 2023

Amit Sethi, Department of Oral and Maxillofacial Surgery, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA

Approved

https://doi.org/10.5256/f1000research.147594.r217295

The authors have done well to highlight the influence weather and environmental conditions can play on the number and type of maxillofacial injuries seen.

The authors have brought up a very unique factor which could influence the number of patients presenting with maxillofacial trauma. The authors have also done well to classify patients based on age, sex and type of injury. Sex of patients may be important and evolve in coming years as more women take up driving.

The authors mention that the effect of rains may be mitigated by the fact that some people choose to stay home because of impending rain. This study is a good pilot study for a more elaborate study to be done in which a) duration can be longer b) the years with "good" or "bad" monsoon can be studied and data analyzed c) comparison can be done across different hospitals situated in places with light / moderate / heavy rain and then compare the variability in type and number of patients coming to emergency rooms with maxillofacial trauma

Overall the article is a good read and discusses an important topic in an objective manner.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dentoalveolar surgery, Anesthesia, Medicine, Trauma

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

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Version 2

VERSION 2 PUBLISHED 19 Oct 2023

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Amit Sethi, Boston University, Boston, USA
Rui Santos, School of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal; Integrated Researcher at the Statistics and Applications Center of the University of Lisbon, Lisboa, Portugal

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5 Views

05 Apr 2024 | for Version 2

5 Views Cite this report Responses(0)

Approved

The authors considered the majority of my comments during the manuscript review, leading to enhancements in its quality.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Statistical inference, data science, meta-analysis and epidemiology, mainly applied to the areas of Medicine and Forensic Science.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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19 Views

20 Feb 2024 | for Version 1

19 Views Cite this report Responses(1)

Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Statistical inference, data science, meta-analysis and epidemiology, mainly applied to the areas of Medicine and Forensic Science.

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Author Response

13 Apr 2024

anand deep shukla, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal , Manipal Academy of Higher Education, Manipal, 576104, India

Thank you for reviewing the manuscript.
Below are the comments raised by the 2nd reviewer along with the replies

Query: The authors state "Univariate analysis was done by Student’s t-test". What was the t-test used for?
Reply : Apologies for the confusion. We have corrected the same. “Data for incidence of soft tissue injuries, dentoalveolar Injuries and various facial fractures were compared between the two seasons i.e., monsoon and non-monsoon using Chi-square or Fishers exact test.”

Query: Tables should be presented (and numbered) in the order in which they are referred to (table 2 is referred to before table 1).
Reply: Tables have been numbered accordingly.

Query: Figure 1 and Table 2 have the same information (and neither adds information in relation to what is in the text). I think they can be both removed.
Reply: Both Figure 1 and Table 2 have been removed.

Query: All information in Table 1 is referred to in the text (this table can also be removed).
Reply: The table has been removed

Query: All information from Table 3 is included in the first lines of Table 4, so this table must be removed.
Reply: The table has been removed

Query: In Table 4, the column headings are clearer if are used in the same way as those in Table 3 (i.e., "Non-monsoon season" and "Monsoon season" instead of 0 and 1). The same occurs in the line designations, where "Absent" and "Present" are clearer than 0 and 1 (even with the explanation in a footnote to the table).
Reply: The column headings are changes to Non monsoon and monsoon season as instructed.

Query: The results section should be developed in order to clarify the results presented, in particular which p-value is presented in Table 4 (i.e., which test was carried out, as it appears to be a comparison test of the proportions observed between the two seasons, but the only test referred in the text is the univariate t-test which is not suitable for this purpose). Moreover, in Table 4, why is "Sig" (significant) the p-value "0.053" on the "FRONTAL BONE", but the p-value "0.021" is not significant in the "ORBITAL FLOOR"?
Reply: The statistical analysis that was carried out was Chi-square or Fishers exact test, the same has been corrected in the manuscript. The p value of 0.021 for orbital floor has been changed to significant as pointed out.

Query: Some discussion and references are related to the etiology of maxillofacial injuries, such as road traffic accidents, falls, assaults, sports injuries, and violence. Moreover, it is stated that "In this study the incidence of maxillofacial trauma due to RTA during the monsoon season was found to be lesser but the severity of trauma was found to be greater". Can the authors provide the data (for example in a table) on which they based this statement? In fact, in the Results section nothing is presented about the etiology of the maxillofacial injuries. If the analyzed data contains information about the etiology, it would be relevant to include this information in summary form in the Results section. Please note that the provided data does not contain any information about the etiology.
Reply: We have omitted the line as per the suggestion.
The included cases were only due to RTA as etiology.

Query: In the discussion, differences in terms of sex are also mentioned ("Men show higher incidence"...). Since the analyzed data contains information about the sex of the patients, what can be concluded from the analyzed data? Is it possible to add results (in the Results section) that highlight the differences between the sexes in the maxillofacial injuries?
Reply: The data highlighting the sex distribution in maxillofacial injuries has been added.

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Competing Interests

Nil

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Reviewer Report

12 Views

31 Oct 2023 | for Version 1

Amit Sethi, Department of Oral and Maxillofacial Surgery, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA

12 Views Cite this report Responses(0)

Approved

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dentoalveolar surgery, Anesthesia, Medicine, Trauma

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Kaur G, Singh A, Mahajan A: Maxillofacial Trauma. Indian J. Anaesth. 2003 Jul 1; 47(4): 290–293.

[2] 2. Akhlaq M, Ali S, Asghar R, et al.: Pattern and etiology of maxillofacial fractures in Lahore, Pakistan. J. Ayub Med. Coll. Abbottabad. 2014; 26(1): 58–61.

[3] 3. Bali RK, Sharma P, Garg A, et al.: A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India. J. Inj. Violence Res. 2013; 5(1): 38–50. Publisher Full Text

[4] 4. Boffano P, Kommers SC, Karagozoglu KH, et al.: Aetiology of maxillofacial fractures: a review of published studies during the last 30 years. Br. J. Oral Maxillofac. Surg. 2014; 52(10): 901–906. PubMed Abstract | Publisher Full Text

[5] 5. Gurung US, Singh G, Mishra M, et al.: Maxillofacial Injuries Related to Road Traffic Accidents: A Five Year Multi Center Analysis. Craniomaxillofacial Trauma & Reconstruction Open. 2020; 3: s-0039-1694708. Publisher Full Text

[6] 6. Agnihotri A, Garg R, Alok A: A study of pattern of maxillofacial trauma in a tertiary care hospital in North India. Natl. J. Maxillofac. Surg. 2011 Jul-Dec; 2(2): 150–154.

[7] 7. Johnson AG, Ravindran V, Ravindran Nair KS, et al.: Variation of Incidence of Maxillofacial Trauma due to Road Traffic Accidents during monsoon and non-monsoon period in Malabar region, Kerala, India. Int. J. Curr. Res. 2020; 12(11): 14505–14509.

[8] 8. Aleksanyan LV, Poghosyan AY, Misakyan MS, et al.: Epidemiology of maxillofacial injuries in “Heratsi” No 1 university hospital in Yerevan, Armenia: a retrospective study. BMC Oral Health. 2022 Apr 12; 22(1): 123. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Khan TU, Rahat S, Khan ZA, et al.: Etiology and pattern of maxillofacial trauma. PLoS One. 2022 Sep 29; 17(9): e0275515. PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Shukla AD: Data for the study on epidemology of maxillofacial trauma. figshare. [Dataset]. Figshare. 2023. Publisher Full Text

Epidemiology of maxillofacial injuries during monsoon and non-monsoon season in India: a data-based retrospective study from a tertiary care dental teaching hospital

Abstract

Keywords

Introduction

Methods

Study design

Subject screening, inclusion and exclusion criteria

Data collection

Statistical analysis

Results

Figure 1. Pie chart showing the sex distribution of the studied maxillofacial trauma cases.

Table 1. Mean age of distribution.

Table 2. Sex distribution.

Table 3. Distribution of maxillofacial fractures in Monsoon and Non-monsoon seasons.

Table 4. Distribution of various types of fractures in Monsoon and Non-monsoon season.

Discussion

Data availability

Underlying data

References

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