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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 7  |  Issue : 1  |  Page : 6-9

Training-related maxillofacial injuries in Cameroon military


1 Department of Community Oral Health, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa; Department of Dentistry, Université des Montagnes, Baganté, Nigeria
2 Department of Dentistry, St. Louis University Institute, Bamenda, Cameroon
3 Department of Periodontics, University of Benin, Benin City, Nigeria
4 Department of Surgery, Military Hospital, Koutaba, Cameroon
5 Department of Dentistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon

Date of Web Publication16-Feb-2016

Correspondence Address:
Clement Chinedu Azodo
Department of Periodontics, Prof. A. O. Ejide Dental Complex, University of Benin Teaching Hospital, P. M. B. 1111, Ugbowo, Benin City, Edo State 300001
Nigeria
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DOI: 10.4103/0976-433X.176484

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  Abstract 

Background: Training-related injuries constitute a major health problem among military worldwide. The objective of the study was to assess military training-related maxillofacial injuries in Cameroon. Materials and Methods: This cross-sectional study was conducted among 300 participants aged 19–60 years in Koutaba training camp in the Western region (Noun division) between May and July 2014. Data were collected using both clinical examination and questionnaires. Results: Data revealed a high risk of military training-related maxillofacial injuries. Males and young participants were the most implicated population. The main causes of the maxillofacial injuries were parachuting followed by high jump and road traffic accidents. Most of those maxillofacial injuries were not handled at the training camp because of the absence of dental service. The most common maxillofacial injuries were lacerations (36.7%), followed by the fracture of the teeth (21.7%) and fracture of the lower jaw (20.0%). The majority (76.0%) of the injured respondents felt personal disturbances; mostly for those with maxillofacial injuries from pain and emotional distress. In addition, they said it impaired esthetics, impaired mastication, and disturb speech to those with missing teeth. Conclusion: Overall training.-related injuries and training.-related maxillofacial injuries constitute a major health problem in military service in Cameroon that needs a success.-oriented preventive strategy.

Keywords: Cameroon, maxillofacial, military


How to cite this article:
Agbor AM, Nossi AF, Azodo CC, Kamga CL, Zing S. Training-related maxillofacial injuries in Cameroon military. SRM J Res Dent Sci 2016;7:6-9

How to cite this URL:
Agbor AM, Nossi AF, Azodo CC, Kamga CL, Zing S. Training-related maxillofacial injuries in Cameroon military. SRM J Res Dent Sci [serial online] 2016 [cited 2019 Aug 22];7:6-9. Available from: http://www.srmjrds.in/text.asp?2016/7/1/6/176484


  Introduction Top


The Cameroon military was established after independence from the French in 1960. The Cameroon Army, Air Force and Navy (including the Naval Infantry), the National Gendarmerie, and the Presidential Guard with 38,000–40,000 population make up the Cameroonian Armed Forces. The Cameroonian Armed Forces have training grounds all over the country, and the notable Air Force bases are located in Garoua, Yaoundé, Douala, Koutaba, and Bamenda.

The Koutaba military base and one of the prominent Air Force bases in the Country having a training facility for all the 3 military units and is the host of the Bataillon des Troupes Aeroportees one of the rapid intervention brigades. Training for airmen of the Cameroonian military and some paramilitary units are carried out at Koutaba. Noncommissioned officers, warrant officers, and general officers also after their training in Koutaba undergo training at the Pole Aeronautique Nationale a Vocation Regionale in Garoua, which is also a regional school where pilots from other African countries train. The purpose of the school is to prepare them for the examination for the French air school (CSEA) in “Salon-de-Provence” (A place in France). Training is carried out in the airborne and prejump training at the Cameroonian parachute training school in Koutaba.

Development and sustenance of high levels of physical fitness necessary in military through routine physical activity is physically demanding and can result in training-related injuries. The training-related injuries constitute a major problem in military populations as they result in work/training time losses, attrition, increased healthcare costs, disabilities, and fatalities and ultimately decreased military readiness.[1],[2],[3] It has been cited among the most important causes of morbidity for military personnel alongside sports, falls, and motor vehicle crashes.[4] These injuries are more prevalent among civilian recruits at military training garrisons during the intensive and rigorous military combat training period. There is a paucity of information on military training-related injuries in developing countries, especially Cameroun necessitated this study. The objective of the study was to assess the military training-related maxillofacial injuries in Cameroon.


  Materials and Methods Top


The protocol for the study was reviewed and approval granted by St. Louis University Institute of Health and Biomedical Science, Bamenda, Cameroun. This cross-sectional survey was conducted in Koutaba training camp in the Western region (Noun division) between May and July, 2014. The target population of research was military in training who consented to participate. Those who did not consent were excluded. Data were collected using both clinical examination and questionnaires. The questionnaires containing closed-ended and opened-ended questions elicited information on demography, injury experience and etiology, type of injury, oral and maxillofacial injury experience, pattern, and care. After questionnaire administration, clinical examination of the participants was carried out in the clinic using gloves and dental mirror. Data were analyzed using Epi Info version 7.1.0.6 (CDC Atlanta, Georgia, USA).


  Results Top


Data were collected from three hundred people in training army camp in Koutaba in the West region of Cameroon. Of 300 participants, 274 (91.3%) were aged between 19 and 39 years and 26 (8.7%) were aged between 40 and 60 years. One hundred and ninety-four (64.7%) were male, and the remaining 35.3% were female. About 103 (34.3%) of them reported traumatic injuries experience linked to training. A total of 4.0% reported having seen death occur from the training-related injury. About one-third (31.1%) of the injuries were parachuting-related [Figure 1]. Most of the injured patients (60.0%) were completely treated at the training camp, 35.2% of them were referred after the first aid treatment, and 4.8% were referred directly. A total of 58.3% of the injuries were located on the face, 33.3% were on the limbs, 9.8% were located on the ribs, and 25.5% were other sites. Of the sixty participants that had maxillofacial injuries, 36.7% of them had lacerations, and 20% had fracture of the lower jaw [Figure 2]. After injury, 47.5% of the participants were treated through mandibular or maxillary reduction, 30% of them had teeth extraction, 12.5% splinting, and 10% were eligible for root canal therapy. The consequences of the injury as described by the participants revealed that about three-quarters (76.3%) of the participants felt personal disturbances (esthetic and mastication impairment, speech disturbances), 15.8% of them were no more comfortable at the training place, and it was difficult for 7.9% of them to deal with their environment (interpersonal relationship).
Figure 1: Causes of injury among the participants

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Figure 2: Pattern of maxillofacial injuries among the participants

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  Discussion Top


The purpose of this research was to assess the military training-related maxillofacial injuries in Koutaba training camp in the Western region. Male participants aged 19–39 years were more affected. This was explainable by finding of the previous study in infantry soldiers which reported younger age and low physical fitness as potential risk factors for these injuries.[5] Katz et al.[6] also reported young males, lower enlisted ranks, recent recruits, and combat-training posts as high-risk factors for dentofacial injuries more than three decades.

About one-third (34.3%) of the participants reported training-related injuries experience highlighting training-related injuries as a major problem in Cameroun military populations which may have an adverse effect on the military readiness.[1] Worse still 4.0% reported having seen mortality from training-related injuries. This, therefore, has an insight collaboration with the report of injuries, as the single leading cause of deaths, disabilities, hospitalizations, outpatient visits, and manpower losses among military service members.[4] Although the prevalence of training-related injuries in this studies was lower than 49.2% reported among infantry soldiers in the United States of America.[7] Canham-Chervak et al.[8] reported physical training, military parachuting, and privately owned vehicle crashes as the three injury causes with the greatest potential for successful program and policy implementation using a data-driven, criteria-based process.

In this study, the overall the prevalence of the military training-related maxillofacial was 20.0% (60/300) which was comparable to 20.4–23.6% reported in Iran.[9],[10] However, it was higher than 6.4% reported among Israeli soldiers and civilians during the Second Lebanon War.[11] This could be due to the fact that patients with only dental injuries and superficial facial soft tissue lacerations in the compared study were excluded. It is also higher than 15.2% reported among British Army infantry soldiers during a predeployment training cycle.[12]

Among the participants that reported injuries in this study, one-third of the participants were on the limbs while the dentofacial area was the second most affected area. These may be explained by the fact that the leading cause of injuries was parachuting followed by high jump which involved landing with the lower limbs. During these landing, excess force may have been exerted on the lower limbs leading to the reported injuries. The training-related injuries also a variable contribution from road traffic accident (RTA), gun manipulation, and fighting with as much as one-fifth (20.20%) of the injuries being RTA-related. Reynolds et al.[7] documented lower extremity overuse injuries as the most common type of injury among infantry soldiers in the United States of America, and Lauder et al.[1] reported knee as the most injured area during sports and physical training among active duty American Army personnel. It is, therefore, important to employ necessary precaution that will help reduce the impact of force on lower limbs as the use of ankle braces can reduce the likelihood of ankle sprains during airborne operations.[13] Employment of driving precautions and use of protective devices twill help to prevent and minimize the impact of RTAs. Although the majority were facial laceration followed by teeth fracture, it is known that it is bone fractures that are more serious and leads to hospitalization. Mandible was more fractured than the middle facial fracture which may be possibly due to the prominence of the mandible and its exposed anatomical position on the face. Mandible occupies very prominent and vulnerable position on the face and lack of chin protection explains this higher prevalence of mandibular than middle face fracture. Khan et al., similarly reported mandible as the most commonly fractured facial bone among Armed Forces of Pakistan.[14] The higher prevalence of mandibular fractures than middle face fractures has also been reported in civilian population.[15] Aljinovic-Ratkovic et al.[16] reported similarity in incidence, pattern and severity of maxillofacial, and associated injuries in civilian and military personnel.

The high prevalence of tooth-related injuries in term of tooth fracture and tooth avulsion showcases the wider implication of dental injuries on appearance and lifelong consequence and related care of traumatic dental injury. All these have a direct impact on the socioeconomic activities that essentially result in lifelong disability and discomfort. Some major trauma injuries such as open fracture of the upper or lower limbs were referred directly (4.76%) to the referral hospital of Douala or Yaoundé for better care. Despite these, some injured participants received just first aid before referral because of the absence of a specialist. However, 60.0% of them received first aid and treatment at the military nursing station in training place; this were for the cases of lacerations and some mild fracture.

It is known that maxillofacial and dental injuries cause morbidity and, therefore, demand meticulously planned treatment. Although 47.5% of the participants were treated through mandibular or maxillary reduction, all of them received first aid at the training camp before referral (35.2%). This is because there is neither a dentist nor maxillofacial surgeon who works at the health station of Koutaba training camp. Also with tooth-related injuries such as fractures of the teeth (21.7%); avulsion (8.3%) were referred to a dentist after first aid.

This study showed that about three-quarters (76%) of the injured participants felt personal disturbances mostly those with maxillofacial injuries. They arose from pain, emotional distress and also from speech disturbance, impaired esthetics, and mastication from missing teeth. Participants with limbs and ribs injuries could no more follow in the training and had impaired daily life; with many of them ended up with prosthesis and were enforced for re-education. A total of 15.0% of them were disturb at the training place because they could not perform as before since, either they are still convalescent, or they still have a negative mind about the training place. Only 7.9% of them had environmental disturbances, they could not deal with the neighboring people as before at time because of the extent of the injury.

The injuries noted in this study, and their impact indicates the need for protected training by overtraining prevention, agility-like training, mouthguards, semi-rigid ankle braces, nutrient replacement, and synthetic socks implementation and improved treatment facilities to improve the combat readiness of Cameroonian military.[17]


  Conclusion Top


Overall training-related injuries and training-related maxillofacial injuries constitute a major health problem in military service in Cameroon that needs a success-oriented preventive strategy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
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2.
Smith GS, Dannenberg AL, Amoroso PJ. Hospitalization due to injuries in the military. Evaluation of current data and recommendations on their use for injury prevention. Am J Prev Med 2000;18 3 Suppl: 41-53.  Back to cited text no. 2
    
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Ruscio BA, Jones BH, Bullock SH, Burnham BR, Canham-Chervak M, Rennix CP, et al. Aprocess to identify military injury prevention priorities based on injury type and limited duty days. Am J Prev Med 2010;38 1 Suppl: S19-33.  Back to cited text no. 3
    
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5.
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6.
Katz RV, Barnes GP, Larson HR, Lyon TC, Brunner DG. Epidemiologic survey of accidental dentofacial injuries among U.S. Army personnel. Community Dent Oral Epidemiol 1979;7:30-6.  Back to cited text no. 6
    
7.
Reynolds KL, Heckel HA, Witt CE, Martin JW, Pollard JA, Knapik JJ, et al. Cigarette smoking, physical fitness, and injuries in infantry soldiers. Am J Prev Med 1994;10:145-50.  Back to cited text no. 7
    
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Canham-Chervak M, Hooper TI, Brennan FH Jr., Craig SC, Girasek DC, Schaefer RA, et al. Asystematic process to prioritize prevention activities sustaining progress toward the reduction of military injuries. Am J Prev Med 2010;38 1 Suppl: S11-8.  Back to cited text no. 8
    
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Kalantar Motamedi MH, Ebrahimi A, Askary A. Oral and maxillofacial injuries in civilian recruits during mandatory combat training at military garrisons: A nationwide survey. Trauma Mon 2012;17:337-40.  Back to cited text no. 9
    
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Motamedi MH, Sagafinia M, Famouri-Hosseinizadeh M. Oral and maxillofacial injuries in civilians during training at military garrisons: Prevalence and causes. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:49-51.  Back to cited text no. 10
    
11.
Levin L, Zadik Y, Peleg K, Bigman G, Givon A, Lin S. Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians. J Oral Maxillofac Surg 2008;66:1630-3.  Back to cited text no. 11
    
12.
Wilkinson DM, Blacker SD, Richmond VL, Horner FE, Rayson MP, Spiess A, et al. Injuries and injury risk factors among British army infantry soldiers during predeployment training. Inj Prev 2011;17:381-7.  Back to cited text no. 12
    
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Jones BH, Knapik JJ. Physical training and exercise-related injuries. Surveillance, research and injury prevention in military populations. Sports Med 1999;27:111-25.  Back to cited text no. 13
    
14.
Khan SU, Khan M, Khan AA, Murtaza B, Maqsood A, Ibrahim W, et al. Etiology and pattern of maxillofacial injuries in the Armed Forces of Pakistan. J Coll Physicians Surg Pak 2007;17:94-7.  Back to cited text no. 14
    
15.
Agbor AM, Azodo CC, Ebot EB, Naidoo S. Dentofacial injuries in commercial motorcycle accidents in Cameroon: Pattern and cost implication of care. Afr Health Sci 2014;14:77-82.  Back to cited text no. 15
    
16.
Aljinovic-Ratkovic N, Virag M, Macan D, Zajc I, Bagatin M, Uglesic V, et al. Maxillofacial war injuries in civilians and servicemen during the aggression against Croatia. Mil Med 1995;160:121-4.  Back to cited text no. 16
    
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Bullock SH, Jones BH, Gilchrist J, Marshall SW. Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med 2010;38 1 Suppl: S156-81.  Back to cited text no. 17
    


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