Maxillofacial Trauma—Psychological Impact

Oral and maxillofacial trauma leads to physical as well as psychological impact on human life. Facial deformity due to trauma is very common as face is prominent part of the body and more susceptible to injuries. The violent mechanism of injury changes in appearance, altered self-perception, and self-confidence can significantly impact on people daily life.

The impact of facial trauma on patients’ psychological health is still not very well understood and overlooked. Affective disorders such as generalizes anxiety, depression, acute stress reaction, and post-traumatic stress disorder are complex. Familiarity with the diagnostic features of common psychological presentation is very important for clinician to recognise.

Multidisciplinary care and treatment can help in improving physical appearance and functional outcome with some residual deformities. The residual deformities can be permanent and can create psychological problems. The psychological burden of living with disfigurement in society where physical beauty play very important role cannot be ignored.

The most significant role of the surgeon and team is to take time to thoroughly listen to the patients and relatives about their concern for surgery, its sequel, and capability of living with deformities. This my need extra time and devotion and sympathetic attitude. If surgical team feels that patient and relatives may be assisted further by psychiatrist or psychologist, immediate reference should be advised.

The core symptoms that will help in recognising and managing psychological impact on patient are as follows:^1–3

Anxiety, depression, acute stress reaction and post-traumatic stress disorder- Persistent nervousness, trembling, muscular tensions, light headiness, palpitation, dizziness and epigastric discomfort.

Depression Core symptoms persistent (in excess of two weeks) low mood, reduced energy, and decreased in activity, anhedonia, loss of interest and concentration, fatigue and poor sleep early morning waking

Additional common symptoms reduced appetite, low self-esteem and self-confidence with feeling of guilt or worthlessness. loss of libido, suicidal thought, thought of self-harm, depending on the symptoms and severity can be classified as mild moderate and severe.

Acute stress reaction Typically, a mixed and changing picture including aa initial state of daze with some constriction of the field of consciousness and narrowing of attention inability to comprehended stimuli and disorientations. This may be followed by further withdrawal or agitation and over activity. Autonomous signs of panic (tachycardia, sweating, flushing) are common. The symptoms usually appear within minutes of the stimulus and disappear within 2-3 days and resolve with in four weeks. Amnesia may be present.

Post traumatic stress disorder Features include repeated reliving of the trauma in intrusive memories (flashback)dreams and night mares occurring against the persisting background of a sense of numbness, and emotional blunting detachment from other people unresponsive anhedonia, and avoidance of activities and situation, reminiscent of the trauma. there is usually a state of hypervigilance, an enhanced startle reaction and insomnia. Anxiety and depression are commonly associated and suicidal idea is common. Symptoms duration is an excess of 4 weeks often lasting years.

The above disorders can pose a significant mental burden for person who may also be suffering considerable physical disability from their injuries.

The most of the facial injuries are due to road traffic accidents and patients are of young age group. Substantial number of patients are associated with alcohol and drugs. Physical scaring and psychological wound may develop overtime and become chronic. The patients who are already experiencing depression, anxiety, small social network, limited social and financial support may be affected with negative sequelae.

Surgical management will repair broken bones soft tissue many of these patients may be at the danger of reinjury or poor psychological out comes because they may not have social and personal resources to make a positive impact on life.

Certain factors can help in identifying disorders so that psychiatry help can be taken as early as possible like presence of anger, irritability, long hospital stay, multiple surgeries, loss of hope for recovery, flashbacks, past history of psychiatric illness and history of familial psychiatric illness.

Anxiety depression and post-traumatic stress are very common in maxillofacial trauma patients but most of the time these problems are ignored and left remain untreated due to lack of proper diagnosis and in our hospitals, there is lack of any protocol for assessment of psychological state of patients and proper referral to the concerned department. Developing and spreading effective psychological educational materials will also address the specific concern for people living with facial disfigurement. A medical multidiscipline approach should be developed and implemented for the better management of patients with maxillofacial trauma.