(0532) The State of Craniomaxillofacial Trauma Care in Low- and Middle-Income Countries: A Scoping Review

Introduction: To review the current literature regarding the management of craniomaxillofacial trauma (CMFT) in low- and middle-income countries (LMICs).

Methods: A comprehensive literature review was conducted in PubMed/MEDLINE, Cochrane Review, EMBASE, ClinicalTrials.gov, and Google Scholar from January 1, 2012, to December 10, 2023. The PRIMSA-ScR was used to guide reporting, and the PRIMSA flow chart was used to document database searches. Specific, pre-defined search terms and novel inclusion criteria were used for screening. Articles were assessed for quality using the STROBE checklist. The database search yielded 54 articles, 13 of which met inclusion criteria. Findings were organized into eight categories, and a composite document was created to compare the reported outcomes and summarize key findings.

Results: A total of 10,420 patients were included (7,739 [74.3%] male, 2,681 [25.7%] female) with a male-to-female ratio of 2.9:1. The mean peak age of incidence of CMFT was 30.8 years with a range of 20-40 years. Road traffic accidents (RTAs) were the leading cause of CMFT (60.4%), followed by assault (27.2%) and falls (12.2%). Of CMFT victims involved in RTAs, 44.9% were not wearing a seat belt or helmet, and 15.4% were intoxicated with alcohol. The most common injuries were soft tissue injury (31.7%), isolated mandibular fracture (22.8%), and isolated middle-third of mandible fracture (18.1%). The most common treatments were closed reduction and immobilization (29.5%), conservative management (27.6%), and open reduction and internal fixation (19.6%). A majority of patients (77.8%) experienced a treatment delay after hospitalization due to a lack of fixation materials (54.8%) or surgeon unavailability (35.7%). The average cost of plating materials was $238.38 or $2,794.66 GDP per capita.

Conclusions: CMFT remains a significant cause of global morbidity, yet there remains a lack of high-quality, CMFT-specific data in LMICs. Further studies are needed to provide country-specific CMFT data on the diagnosis, treatment, outcomes, barriers to care, and impact of novel interventions.