What Is the Relationship Between Maxillofacial Injury Location and Associated Injuries?

Abstract

BackgroundPatients sustaining maxillofacial fractures are at risk for associated injuries to other body regions. The incidence of associated injuries (AIs) is reported to be from 20 to 35%. AIs may be life-threating and play a key role in considering first-line management at the emergency department, as well as planning the definitive treatment of maxillofacial fractures. PurposeThe study aimed to determine the frequency and risk factors for AIs in patients with maxillofacial fractures. Study design, settings, sampleThe investigators designed and implemented a retrospective cohort study of patients with facial fractures treated at Central Hospital (Lahti, Finland) from January 1, 2009 through December 31, 2019. All adult patients with verified maxillofacial fractures were included. Patients under 18 years were excluded from the study. Predictor variableThe predictor variable was the location of the maxillofacial fractures grouped into three categories, mandible alone, midface alone, both midface and mandible. Main outcome variableThe primary outcome variable was associated body region injuries coded as present or absent. The secondary outcome variable was the location of the AI categorized as skull, neck, thorax, pelvis, or extremity injuries. CovariatesOther study variables included demographic data (age, sex, alcohol use), Glasgow Coma Scale (GCS), and etiology (fall, traffic- and bicycle accident, assault, pedestrian hit by motor vehicle, work-related, or sports/free-time injuries). AnalysesContinuous variables were analyzed for normal distribution using the Shapiro-Wilks test and compared with categorical variables using the Mann-Whitney test. The univariate analyses of categorical variables were analyzed by the x2 test (P ≤ 0.05 was considered statistically significant). ResultsDuring the study period, 443 adult (≥18) patients had maxillofacial fractures. AIs were present in 88 subjects (20%). The mean age was 47.6 years (range 18-91); 52 years with AIs (range 19-91), and 47 years (range 18-92) without AIs (p = 0.03). Subjects with midface and mandible + midface fractures had greater risk to AIs compared to mandibular fractures. (RR 2.0, p=0.002, RR 2.8, p=0.009). Conclusions and RelevancyEvery fifth maxillofacial trauma patient had associated injury. Trauma patients should be evaluated in institutions with trauma protocols and imaging modalities before determining and executing the treatment plan for maxillofacial fractures.