Operators Of All-Terrain Vehicles Are At High Risk For Severe Injuries To The Jawbone And Face

B. Joseph Touma, MD, and Hassan H. Ramadan, MD, both from the Department of Otolaryngology-Head and Neck Surgery at West Virginia University conducted this research. Their findings were presented before 1998 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting and OTO Expo, which is being held September 13-16 at the Henry B. Gonzalez Convention Center in San Antonio, TX.

Background

All-terrain vehicles were introduced into the United States in the late 1970s and have become a popular form of motorized recreation, particularly in off-road areas. These vehicles can weigh up to 500 lbs. and exceed speeds 65 mph. Three and four wheel vehicles were available until 1988 when the federal government banned the former due to high rates of death and injury.

Between January 1982 and June 1995, the U. S. Consumer Product and Safety Commission reported 2,638 deaths nationwide due to ATV accidents of which 73 occurred in West Virginia. While the death rate has declined, there are still significant injuries requiring emergency room treatment. In 1994, 59,200 such injuries were reported; 24,800 were for patients under 16 years of age. This research study is the first of its kind addressing maxillofacial (jaws and face) injuries due to ATV accidents.

Methodology

The study was a retrospective review of 153 patients admitted to the West Virginia University hospital system between January, 1990, and June, 1996. Of this group, 33 suffered at least one maxillofacial injury (facial and scalp lacerations were not included). Data obtained included patient age, time of accident, type of vehicle, scene of accident, helmet status, use of alcohol, injuries, and length of stay in the intensive care unit and hospital.

Results

Of the 33 patients with maxillofacial injuries, the average age was 28.2 years versus 25.9 years for those injured without facial trauma. Other data included:

All the accidents occurred off-road. Most occurred in May, June, and July; Saturday night was the most common night for accidents. Males exceeded females at a rate of nearly five to one.

Twenty one percent of those suffering maxillofacial injuries were under 16 years old. Children had higher injury severity scores and a higher rate of ICU admission than adults. Slightly more than half of the nighttime accidents and one fifth of the day accidents were alcohol related.

The most common maxillofacial injuries were mandible ( a u-shaped bone in the lower jaw) fractures followed by orbital floor (part of the bony cavity containing the eyeball) fractures. More than one fourth of patients with maxillofacial injuries required treatment in the intensive care unit, twice the rate of those without facial trauma. The average hospital stay for facial and jaw injuries was 6.52 days compared to 4.8 days for other injuries.

Surgery was performed on 25 of the 33 patients with maxillofacial injuries with the most common procedure being intermaxillary fixation (wiring one's jaw together). Ten patients required one procedure, seven patients two, seven patients required three, and two patients required four procedures.

Injury rates, time in the intensive care unit, and length of hospital stay were all higher for children than adults.

Only one of the 33 patients with facial injuries reviewed had a helmet on and no alcohol involved.

Conclusion

The researchers conclude that the severity of maxillofacial injuries and the extensive treatment required should be major factor when one is considering purchasing an ATV, especially for a minor. Additionally, the injury rate suggests that formal training in operating the vehicles should be made mandatory.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting and OTO Expo is being held in San Antonio, TX, from September 13-16. More than 8,000 participants are expected for scientific sessions, exhibits, posters, and a research program.