Frequency and management of complex facial fractures-an oral and maxillofacial surgical assessment

Abstract

The treatment of facial fractures is an integral part of the oral and maxillofacial surgical treatment spectrum. In the case of complex fractures that involve multiple levels of the facial skeleton associated with severe concomitant injuries, an individual and interdisciplinary treatment approach is needed, which requires the infrastructure of anational trauma center. The aim of this study was to analyze the incidence and management of patients with complex facial fractures and considering the concomitant injury pattern. A retrospective analysis of patients with complex facial fractures during the years 2009-2015 admitted to the emergency surgical department of anational trauma center was carried out. The identification of appropriate patient cases was based on the International Statistical Classification of Diseases and Related Health Problems (ICD) coding of electronic patient data. Only patients with at least acombination of mandibular and midfacial fractures (2-level fractures) were considered. Patients with mainly dentoalveolar fractures and simple nasal bone fractures were not included. The evaluation of the electronic medical records included the etiology, fracture pattern, associated severe injuries on the basis of the injury severity score (ISS), treatment regimen as well as the length of the hospital stay. In the 7‑year study period, 3382 patients were identified with facial fractures. Of these, 128 patients (3.78%) presented with acomplex fracture pattern with acombination of mandibular fractures and fractures of the midface. The majority of these patients (n = 92) had less severe concomitant injuries (ISS ≤ 16), while 36patients showed severe concomitant injuries (ISS > 16). The incidence of a3-level fracture involving the mandible, midface and anterior skull base was only 0.47% and could be detected in 16patients, of which 10 were classified as polytrauma (ISS > 16). The incidence of complex fractures of the facial skeleton was comparatively low with almost 4%. More than one in four patients with complex injury patterns of the facial skeleton exhibited severe concomitant life-threatening injuries, necessitating an interdisciplinary management with the specialized infrastructure of anationwide trauma center.