Clinical Review of Cases of Oral and Maxillofacial Bone Fractures due to Suicide Planning in the Past 16 Years

Each year approximately 200 patients who have attempted suicide are transported to the Advanced Critical Care Center of the Tokyo Metropolitan Bokutoh Hospital. About 20% of these patients suffer from high-energy trauma caused, for example, by jumping off a building resulting in multiple traumas. We report herein a clinical review of 27 cases of oral and maxillofacial fractures who had been injured in suicide attempts, among 574 cases treated in our department over 16 years from January 2006 to December 2021. <br>Of the 27 cases, 16 had a history of psychiatric treatment, 3 were diagnosed with mental illness after hospitalization, and 8 were due to short-circuit reactions. The psychiatric liaison team intervened in these patients from the early stages of their treatment at the hospital, enabling early stabilization of the mental status of patients with short-circuit reactions to suicide attempts, and treatment with mental rest and sedation in patients with mental illness. <br>Fracture sites were as follows: mandible alone in 16 cases, maxilla and mandible in 4 cases, mandible and zygoma in 1 case, maxilla and zygoma in 1 case, and maxilla, mandible and zygoma in 5 cases. All patients underwent surgical repair and fixation under general anesthesia, while surgical repair and fixation was performed for condylar process fracture in 3 of 12 cases. Comminuted fractures were the most common type of fracture, both for the maxilla and mandible, and for these patients we often had difficulties in reconstructing the occlusion. <br>In the case of high-energy trauma, airway clearance and hemostasis were often the initial treatment, and intraoral bleeding was often a cause of intubation difficulties. In addition, patients who had attempted suicide show severe body movements due to impaired consciousness and restlessness on the day of transport, and the risk of aspiration of agitated teeth and fractured fragments is increased. Therefore, it is considered important to work closely with the emergency department.