The Pattern of Combined Maxillofacial and Cervical Spine Injuries

Abstract

Facial fractures can be isolated or a component of multiple trauma. Cervical spine injuries are known to occur concomitantly with facial fractures. Failure to diagnose such injuries carries a significant risk of causing neurologic abnormalities, long-term disability and even death. The aim of this article is to examine the association between maxillofacial and c-spine injuries to provide guidance in diagnosis and care of patients with combined injuries. Of the 1,222 patients with spine fractures who were admitted to Thomas Jefferson University Hospital between January 2000 and June 2006, 701 patients had cervical spine fractures. Among those, 44 patients (6.28%) had combined cervical spine and maxillofacial fractures. The raw data of these 44 patients were entered into SPSS, statistical package for social sciences, version 14 for data analysis. The study variables included patients’ gender, mechanism of trauma, type and complexity of c-spine injury, and type and complexity of facial fractures. Descriptive statistics were performed in which the frequencies of the variables were presented and then exploration of the interaction between the different variables was carried out. The most common cause of trauma was MVA (45.5%) followed by falls (36.4%). In regards to the types of maxillofacial fractures, 27.3% of the cases presented with isolated orbital fractures and 13.6% with isolated mandibular fractures. Combination fractures constituted the reminder of the cases. The most frequent level of c-spine fracture was isolated C2 fractures (31.8%) followed by isolated C4 and C6 fractures (6.8% each), while isolated C1, C3, C5 and C7 fractures, and the combinations of C1 and C2, and C5 and C6 fractures accounted for 4.5% each. When the mechanism of trauma was compared to the types of c-spine and maxillofacial fractures, falls were found to be the most frequent mechanism causing isolated orbital and C2 fractures. This study reveals a 6.8% incidence rate of combined cervical spine and maxillofacial fractures. This incidence rate is lower than what was reported in previous studies that ranged between 15-20%. However, those studies focused on severe spinal injuries. Hackle et.al. found that the presence of c-spine fractures or dislocations coincides with a five fold increase in the occurrence of a facial injury, compared with a simple cervical spine injury. A regression analysis study showed that the risk of sustaining additional c-spine injury in facial trauma patients increases every year by 1.7%. Although falls resulted in the most frequent types of c-spine and facial fractures, C2 and orbital fractures, MVA remained the most common mechanism of trauma that produced combined c-spine and facial fractures. There is a 3-fold increased risk of sustaining combined maxillofacial and c-spine injuries in traffic vs. non-traffic accidents. It was found that the most frequent two patterns of combinations of c-spine and facial fractures were the combination of isolated orbital and C2 fractures, and isolated mandibular and C2 fractures. Furthermore, 68.2% of the combined c-spine and facial fracture cases involved orbital fractures of some form. Alvi et.al. found that orbital fractures are the most common maxillofacial injury associated with concomitant injuries, weather cerebral, pulmonary, abdominal or cervical, accounting for 24.2% of cases.