Facial fractures and concomitant injuries in trauma patients

Maxillofacial fractures often occur with serious concomitant injury in trauma patients, and knowledge of the type and severity of associated injuries can assist in rapid assessment and treatment. The objective was to identify the most commonly occurring injuries associated with facial fractures in severely injured trauma patients.

Review of medical records.

A retrospective review was made of 151 patients with facial fractures presenting to a level-one trauma center over a 4-year span. All patients had an injury severity score of 12 or greater. Chart data recorded included demographics, etiology, presentation, facial fracture site, concomitant injury, imaging studies, hospital stay and course, interventions, and outcome.

The most common cause or origin of facial fracture was assault (41%), followed by motor vehicle accident (26.5%). Orbital fracture was the most common overall facial fracture (24.2%), with nasal fractures being the most common isolated fracture (23.2%). Cerebral hematoma occurred in 43.7% of patients, with subdural hematoma being the most frequent. Pulmonary injury was the second most commonly associated injury (31.1%) with lung contusion being the most frequent. Seventy-two patients (42%) required intubation, and 22 (14.8%) required tracheostomy during their hospital stay. The hospital complication rate was 50.3% and included primarily pulmonary complications, septicemia, renal failure, and severe anemia. Thirteen patients died during their hospital stay; 11 of them died of neurologic injuries, 1 of pulmonary failure, and 1 of overwhelming sepsis.

Cerebral and pulmonary injuries are often associated with maxillofacial fractures in severely injured trauma patients. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of patients with facial fractures.