Mitchener Timothy A, Dickens Noel E, Simecek John W
United States Army Institute of Surgical Research, 3650 Chambers Pass, Bldg. 3610, Joint Base San Antonio/Fort Sam Houston, TX 78234.
Naval Medical Research Unit San Antonio, 3650 Chambers Pass, Bldg. 3610, Joint Base San Antonio/Fort Sam Houston, TX 78234.
Mil Med. 2018 Mar 1;183(3-4):e219-e224. doi: 10.1093/milmed/usx083.
Few studies have examined the causes or mechanisms of oral-maxillofacial (OMF) injury among deployed military populations. This study reports causes of OMF injuries to U.S. Department of Defense personnel deployed to Afghanistan in Operation Enduring Freedom (OEF) or to Iraq in Operation Iraqi Freedom (OIF) and Operation New Dawn (OND). This study provides follow-on analysis of a previous report of OMF injury rates among U.S. military personnel in Iraq and Afghanistan from 2001 to 2014.
The populations studied were military personnel deployed to Afghanistan in OEF or Iraq in OIF and OND, who sought care at a level III military treatment facility for one or more OMF injuries. Injuries were identified in the Department of Defense Trauma Registry using diagnosis codes associated with OMF battle and non-battle injuries. Causes associated with these injuries were identified by evaluation of the data field "dominant injury mechanism." All OMF injuries incurred from October 19, 2001, to June 30, 2014, were included.
FINDINGS/RESULTS: Approximately 89% of all OMF battle injuries in both OIF/OND and OEF were due to explosives or explosive devices. The three leading causes of OMF non-battle injuries for both OIF/OND and OEF were motor vehicle crashes/accidents (MVCs), falls, and "other blunt" trauma. MVCs as well as other blunt trauma accounted for a greater percentage of OMF non-battle injuries in OIF/OND than in OEF (p < 0.01). OMF non-battle injuries due to falls were more likely to occur in OEF (p = 0.05). Helicopter/plane crashes were responsible for a significantly higher percentage of OMF non-battle injuries in OEF compared with OIF/OND (p < 0.01).
DISCUSSION/IMPACT/RECOMMENDATIONS: Across both theaters of war, Iraq and Afghanistan, the main causes of OMF battle and non-battle injuries were consistent. Battle injuries were primarily due to explosives or explosive devices and the three main causes of non-battle injuries were MVCs, falls, and other blunt trauma. However, the distribution of causes differed by war theater. Future studies should focus on potential reasons for cause distribution disparities in MVCs and helicopter/plane crashes as they can only be partially explained by topography and infrastructure differences between Iraq and Afghanistan. Further surveillance is needed to understand the scope of OMF injuries in military-armed conflicts and operations.
很少有研究探讨过部署在军事行动中的人员发生口腔颌面（OMF）损伤的原因或机制。本研究报告了在持久自由行动（OEF）中部署到阿富汗、或在伊拉克自由行动（OIF）及新黎明行动（OND）中部署到伊拉克的美国国防部人员发生OMF损伤的原因。本研究对之前一份关于2001年至2014年期间美国在伊拉克和阿富汗军事人员OMF损伤率报告进行了后续分析。
研究人群为在OEF中部署到阿富汗、或在OIF及OND中部署到伊拉克的军事人员，他们因一处或多处OMF损伤在三级军事治疗机构接受治疗。通过使用与OMF战斗和非战斗损伤相关的诊断编码，在国防部创伤登记处识别损伤情况。通过评估“主要损伤机制”数据字段来确定与这些损伤相关的原因。纳入了2001年10月19日至2014年6月30日期间发生的所有OMF损伤。
在OIF/OND和OEF中，所有OMF战斗损伤中约89%是由爆炸物或爆炸装置所致。OIF/OND和OEF中OMF非战斗损伤的三大主要原因是机动车碰撞/事故（MVC）、跌倒和“其他钝性”创伤。与OEF相比，MVC以及其他钝性创伤在OIF/OND的OMF非战斗损伤中占比更高（p<0.01）。因跌倒导致的OMF非战斗损伤在OEF中更易发生（p=0.05）。与OIF/OND相比，直升机/飞机坠毁在OEF的OMF非战斗损伤中所占比例显著更高（p<0.01）。
讨论/影响/建议：在伊拉克和阿富汗这两个战区，OMF战斗和非战斗损伤的主要原因是一致的。战斗损伤主要是由爆炸物或爆炸装置所致，非战斗损伤的三大主要原因是MVC、跌倒和其他钝性创伤。然而，不同战区的原因分布有所不同。未来的研究应关注MVC以及直升机/飞机坠毁中原因分布差异的潜在原因，因为伊拉克和阿富汗之间的地形和基础设施差异只能部分解释这些差异。需要进一步监测以了解军事武装冲突和行动中OMF损伤的范围。
