Our long-term goal is to reduce the morbidity associated with orofacial injury by identifying treatments that provide affordable, high-quality care. The proposed investigation derives from the recognition that orofacial injury is a condition that disproportionally affects minorities; yet, its physical, economic and psychosocial repercussions are poorly understood. Although the immediate physical aftermaths of orofacial injury are often readily apparent, the nature and extent of long-term physical morbidity are not clearly defined and probably set the stage for subsequent psychosocial morbidity. Even when agreement exists for the operative management of these injuries, there is little consensus in the specific types of treatments that offer the best outcomes. The purpose of this study is to extend preliminary data obtained during Phase I by assessing different outcomes associated with various treatments for orofacial injury, and to do so from a physical, economic and psychosocial perspective. The study is based on the hypothesis that the prevailing management of simpler orofacial injuries are less expensive initially, but more expensive and with greater adverse physical and psychosocial consequences than alternative (initially more expensive) treatments in the long-term. The aims of the study are: 1) to improve understanding of the mechanisms and etiology of orofacial injury in an urban minority population; 2a) to describe and compare the physical, economic and psychosocial outcomes between groups of orofacial trauma victims treated with either Maxillomandibular Fixation or Rigid Internal Fixation; 2b) to compare the physical, economic and psychosocial outcomes within a group of orofacial trauma victims treated with one of three popular Rigid Internal Fixation systems; 3) to compare the frequency of adverse psychosocial sequelae in a cohort of orofacial trauma victims to a comparison cohort of patients undergoing elective oral surgery; and 4) to predict which orofacial trauma victims are most likely one year post- injury to have adverse psychosocial outcomes. This will be done with a four-year prospective longitudinal study of a cohort of about 480 patients treated at the King-Drew Medical Center for orofacial injury. A comprehensive morbidometric methodology incorporating instruments such as the Orofacial Injury Severity Score, Symptom Severity Score and the Craniomandibular Dysfunction Index will measure the physical consequences of the injury. The costs of care associated with each treatment approach will also be collected. Psychosocial adjustments to injury will be assessed by a battery of standardized social and psychological scales, and results correlated with long-term outcomes, including compliance with therapy and function post-injury. Data from each component will be analyzed to test the hypothesis and to identify cost-effective treatments that reduce the consequences of injury. A comparison cohort of 80 sociodemographically matched patients undergoing elective oral surgery will be included to estimate the additional psychosocial effects of orofacial injury and factors predictive of adverse outcomes. The results of this study will clarify significant gaps in our knowledge about the natural history of individual orofacial injuries, have a dramatic and immediate impact on the management of orofacial injury by providing a rational basis for clinical decisions, establish regional and international standards of care and ultimately prepare the foundation for more effective prevention programs.
NIH ExPorter
NIH ExPorter