{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:20:25Z","timestamp":1787649625100,"version":"build-2736575974"},"reference-count":28,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: COVID-19 restrictions altered population mobility and healthcare use. Most reports describe changes in facial-trauma counts; fewer characterise how injury composition changed or separate policy-associated changes from the secular trend. We examined the volume and structure of maxillofacial trauma around the March 2020 restrictions and the January 2022 easing of restrictions. Materials and Methods: A retrospective study of 3954 patients treated for confirmed facial fractures between 2018 and 2023 at three Slovak tertiary centres. The primary outcome was the monthly count of treated cases (case volume, not incidence, as no catchment denominator was available), modelled by segmented negative binomial regression with level and slope terms at two a priori interruptions and harmonic seasonality. Centre\u2013month panel, centre-specific, and leave-one-centre-out models addressed between-centre heterogeneity. Structural outcomes were modelled by segmented binomial regression at the patient level, adjusting for centre, mechanism, sex, and age. Results: The restrictions were followed by a non-significant reduction in monthly case volume (count ratio 0.84, 95% confidence interval CI 0.67\u20131.04), and the easing was followed by an increase in the pooled series (1.50, 95% CI 1.22\u20131.86). This increase was strongly heterogeneous between centres (p &lt; 0.001), was confined to one centre (1.86, 95% CI 1.42\u20132.43), and was compatible with no change once that centre was excluded (1.15, 95% CI 0.88\u20131.50). The non-mandibular fracture share fell at the onset of restrictions (odds ratio 0.54, 95% CI 0.38\u20130.77) and returned thereafter; the post-easing estimate was inconclusive. Electric-scooter injuries rose on a secular trend, with no level shift at either interruption. Conservative management increased at the easing and persisted after adjustment for case mix and centre (aOR 1.44, 95% CI 1.22\u20131.70). Conclusions: These periods were associated with changes in maxillofacial trauma composition, most consistently a shift toward conservative management. The post-easing volume rise was centre-specific, not a national rebound.<\/jats:p>","DOI":"10.3390\/medicina62091628","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:00:48Z","timestamp":1787644848000},"page":"1628","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Volume and Structure of Maxillofacial Trauma Before, During, and After COVID-19 Restrictions: A Multicentre Interrupted Time-Series and Period-Comparative Analysis of 3954 Patients"],"prefix":"10.3390","volume":"62","author":[{"given":"Ladislav","family":"Czako","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Bratislava Ruzinov, Faculty of Medicine, Comenius University, Ruzinovska 6, 826 06 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1819-7780","authenticated-orcid":false,"given":"Maria","family":"Janickova","sequence":"additional","affiliation":[{"name":"Department of Stomatology and Maxillofacial Surgery, University Hospital Martin, Jessenius Faculty of Medicine, Comenius University, Kollarova 2, 036 59 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branislav","family":"Borza","sequence":"additional","affiliation":[{"name":"Department of Stomatology and Maxillofacial Surgery, Louis Pasteur University Hospital Kosice, Faculty of Medicine, Pavol Jozef Safarik University, Rastislavova 43, 041 90 Kosice, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Kalmanova","sequence":"additional","affiliation":[{"name":"Department of Stomatology and Maxillofacial Surgery, University Hospital Martin, Jessenius Faculty of Medicine, Comenius University, Kollarova 2, 036 59 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rastislav","family":"Juricek","sequence":"additional","affiliation":[{"name":"Department of Stomatology and Maxillofacial Surgery, University Hospital Martin, Jessenius Faculty of Medicine, Comenius University, Kollarova 2, 036 59 Martin, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Sovis","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Bratislava Ruzinov, Faculty of Medicine, Comenius University, Ruzinovska 6, 826 06 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kobyliakova","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Bratislava Ruzinov, Faculty of Medicine, Comenius University, Ruzinovska 6, 826 06 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kizek","sequence":"additional","affiliation":[{"name":"Department of Stomatology and Maxillofacial Surgery, Louis Pasteur University Hospital Kosice, Faculty of Medicine, Pavol Jozef Safarik University, Rastislavova 43, 041 90 Kosice, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.bjoms.2020.04.035","article-title":"Impact of COVID-19 epidemic on maxillofacial surgery in Italy","volume":"58","author":"Allevi","year":"2020","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s10006-024-01248-9","article-title":"Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany\u2014Implications from the national DRG database","volume":"28","author":"Meisgeier","year":"2024","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.jobcr.2022.07.012","article-title":"Changing patterns of oral and maxillofacial injuries before and during the COVID-19 pandemic: A retrospective study","volume":"12","author":"Shenoi","year":"2022","journal-title":"J. Oral Biol. Craniofac. Res."},{"key":"ref_4","first-page":"945","article-title":"Repercussions of the COVID-19 pandemic on the epidemiology of facial fractures: A retrospective cohort study","volume":"28","author":"Pierote","year":"2024","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s12663-020-01484-y","article-title":"Incidence of maxillofacial trauma amid COVID-19: A comparative study","volume":"21","author":"Vishal","year":"2022","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.joms.2020.12.006","article-title":"What is the effect of COVID-19-related social distancing on oral and maxillofacial trauma?","volume":"79","author":"Ludwig","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/19433875211002050","article-title":"Maxillofacial trauma and COVID-19: A review of the first 6 months of the pandemic","volume":"15","author":"Press","year":"2022","journal-title":"Craniomaxillofac. Trauma. Reconstr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.bjoms.2020.09.006","article-title":"COVID-19 social-distancing measures altered the epidemiology of facial injury: A United Kingdom\u2013Australia comparative study","volume":"59","author":"Hoffman","year":"2021","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13202","DOI":"10.1038\/s41598-024-63890-3","article-title":"Impact of the COVID-19 pandemic on the dynamics of patients with oral and maxillofacial trauma: Interrupted time-series analysis","volume":"14","author":"Tatsumi","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"St\u00f6rmann, P., Klug, A., Nau, C., Verboket, R.D., Leiblein, M., M\u00fcller, D., Schweigkofler, U., Hoffmann, R., Marzi, I., and Lustenberger, T. (2020). Characteristics and injury patterns in electric-scooter related accidents\u2014A prospective two-center report from Germany. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051569"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1016\/j.joms.2019.07.014","article-title":"Craniofacial injuries seen with the introduction of bicycle-share electric scooters in an urban setting","volume":"77","author":"Trivedi","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_12","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: A tutorial","volume":"46","author":"Cummins","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1046\/j.1365-2710.2002.00430.x","article-title":"Segmented regression analysis of interrupted time series studies in medication use research","volume":"27","author":"Wagner","year":"2002","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jclinepi.2020.02.006","article-title":"Design characteristics and statistical methods used in interrupted time series studies evaluating public health interventions: A review","volume":"122","author":"Turner","year":"2020","journal-title":"J. Clin. Epidemiol."},{"key":"ref_16","unstructured":"Government of the Slovak Republic (2026, July 17). Resolution No. 111 of 11 March 2020 on the Declaration of an Extraordinary Situation for the Territory of the Slovak Republic, Effective from 06:00 on 12 March 2020. Official Register of Government Resolutions, Available online: https:\/\/rokovania.gov.sk\/RVL\/Resolution\/18249\/1."},{"key":"ref_17","unstructured":"Government of the Slovak Republic (2026, July 17). Resolution No. 114 of 15 March 2020 on the Declaration of a State of Emergency for Healthcare Providers, Effective from 16 March 2020; Extended and Amended by Resolutions No. 115 of 18 March 2020, No. 169 of 27 March 2020, No. 207 of 6 April 2020 and No. 233 of 16 April 2020, and Terminated by Resolution No. 366 of 10 June 2020 (Promulgated as No. 147\/2020 Coll.). Collection of Laws of the Slovak Republic, Available online: https:\/\/www.slov-lex.sk\/pravne-predpisy\/SK\/ZZ\/2020\/147\/20200610."},{"key":"ref_18","unstructured":"Public Health Authority of the Slovak Republic (\u00darad Verejn\u00e9ho Zdravotn\u00edctva SR) (2026, July 17). Measure No. OLP\/2576\/2020 of 12 March 2020 on the Closure of Specified Premises and Services at Risk to Public Health. Register of Superseded COVID-19 Measures, Available online: https:\/\/uvzsr.sk\/documents\/41637\/496193\/Opatrenie_UVZSR_pri_ohrozeni_verejneho_zdravia_12.03.2020_prevadzky.pdf."},{"key":"ref_19","unstructured":"Public Health Authority of the Slovak Republic (\u00darad Verejn\u00e9ho Zdravotn\u00edctva SR) (2026, July 17). Measure No. OLP\/2595\/2020 of 15 March 2020, Closing All Retail Outlets and Service Premises Other than Food Shops, Pharmacies, Banks, Post Offices and Fuel Stations, Effective from 06:00 on 16 March 2020. Register of Superseded COVID-19 Measures, Available online: https:\/\/uvzsr.sk\/documents\/41637\/496193\/Opatrenie_UVZ_SR_o_zakaze_a_obmedzeni_prevadzok_15032020.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/s41562-021-01079-8","article-title":"A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker)","volume":"5","author":"Hale","year":"2021","journal-title":"Nat. Hum. Behav."},{"key":"ref_21","unstructured":"Public Health Authority of the Slovak Republic (\u00darad Verejn\u00e9ho Zdravotn\u00edctva SR) (2026, July 17). Decree No. 2\/2022 Ordering Measures Restricting Mass Gatherings. Bulletin of the Government of the Slovak Republic, Published 11 January 2022, Effective 12 January 2022, Available online: https:\/\/www.minv.sk\/swift_data\/source\/verejna_sprava\/vestnik_vlady_sr_rok_2022-2023\/vyhlaska_2.pdf."},{"key":"ref_22","unstructured":"Public Health Authority of the Slovak Republic (\u00darad Verejn\u00e9ho Zdravotn\u00edctva SR) (2026, July 17). Decree No. 5\/2022 Ordering Measures Restricting Mass Gatherings, Effective 19 January 2022, Superseding Decree No. 2\/2022 and Introducing the Relaxed Capacity and Access Regime; Further Relaxations Followed on 26 February 2022 and 14 March 2022, and Entry Restrictions Ended on 6 April 2022. Bulletin of the Government of the Slovak Republic; Register of Superseded COVID-19 Measures, Available online: https:\/\/uvzsr.sk\/documents\/41637\/496193\/vyhlaska_5.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1093\/ije\/dyt092","article-title":"Time series regression studies in environmental epidemiology","volume":"42","author":"Bhaskaran","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. B"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sada-Urmeneta, A., Tousidonis, M., Navarro-Cuellar, C., Ochandiano, S., Navarro-Cuellar, I., Khayat, S., Ruiz-De-Le\u00f3n, G., Benito-Anguita, M., Alvarez-Mokthari, S., and Olavarria, E. (2024). Dynamic trends in surgical oromaxillofacial trauma epidemiology: A comparative study of pre-COVID-19 and COVID-19 periods in tertiary referral hospitals in Madrid. J. Clin. Med., 13.","DOI":"10.3390\/jcm13071947"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.ijom.2020.10.005","article-title":"Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: A French multicentre comparative study","volume":"50","author":"Sigaux","year":"2021","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Salzano, G., Maffia, F., Vaira, L.A., Fusco, R., Albanese, M., Crimi, S., Cucurullo, M., Maglitto, F., Maugeri, C., and Petrocelli, M. (2024). The impact of standing electric scooters on maxillofacial fractures: An Italian multicentric epidemiological study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175195"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/j.bjoms.2024.07.009","article-title":"Electric scooter-related oral and maxillofacial injuries in Oxfordshire","volume":"62","author":"Dhar","year":"2024","journal-title":"Br. J. Oral Maxillofac. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1628\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:34:43Z","timestamp":1787646883000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medicina62091628"],"URL":"https:\/\/doi.org\/10.3390\/medicina62091628","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}