Facial Fractures: Associated Injuries and Complications

Abstract

JG Thomson, HC Brown, RA Brown, DM Fleiszer. Facial fractures: Associated injuries and complications. Can J Plast Surg 1994;1(4):160-165. The forces necessary to produce a facial fracture are often high enough to cause other severe, life-threatening injuries. Despite this knowledge, little is known about the frequency or nature of these injuries. A retrospective chart review was performed on 162 facial fracture patients for associated injuries and complications. These patients were divided into high velocity (n=95) and low-velocity (n=67) groups based on the mechanism of injury, and were compared with a group of 346 multiple trauma patients who did not sustain any facial fracture. Those patients involved in high-velocity accidents had a significantly higher proportion of multiple facial fractures (40%), presence of associated injury (84%), complication rate (38%), mortality rate (9.5%), mean hospital stay (45 days), and mean trauma score (20.1±1.3) when compared with patients in low-velocity accidents (10%, 12%, 10%, 4.3 days and 4.7±0.6, respectively). Although high-G facial bone fractures were more frequent in high-velocity accidents, high-G fractures were not an independent indicator of the severity of injury as measured by the trauma score. The most significant indicator of severity of injury was the mechanism of injury. Pulmonary (15%), cerebral (11 %), septic (7%), abdominal (7%) and cardiac (2%) complications after high-velocity injuries were more frequent than previously reported. Although cervical spine injury has traditionally been associated with facial fractures, the results of this study demonstrated that spinal injury can occur at any vertebral level, and was equal in frequency in patients with and without facial fractures. Statistical analysis of occupant restraint revealed that there was no significant difference between the numbers of patients wearing their seat belts (11) and those not using them (12), the proportions with high-G, low-G, or multiple facial fractures, the incidence of head injury or other associated injuries, the trauma score, and the times spent in the surgical intensive care unit and hospital. Although the lack of significance is probably attributable to the low documentation of seat belt use, the question of the efficacy of seat belts in preventing facial fractures and associated injuries is raised. Patients with facial fractures had a significantly higher mean trauma score (27.9±1.4) and incidence of head injury (54%) compared with patients without facial fractures (23.2±0.7 and 11%, respectively). The surgical treatment of this group of facial fracture patients was analyzed.