Frequency and patterns of CMF emergency cases during and after COVID-19

Craniomaxillofacial (CMF) trauma constitutes a significant proportion of hospital presentations, often resulting from high-energy mechanisms such as interpersonal violence and traffic accidents. The COVID-19 pandemic and associated public health restrictions markedly altered daily life and social behavior, potentially influencing trauma patterns and emergency healthcare utilization.

We conducted a retrospective analysis of nationwide anonymized inpatient data from German hospitals, reported to the National Institute for the Hospital Remuneration System (InEK), covering the period from March 18, 2019 to March 17, 2023. CMF trauma cases were identified using ICD-10 codes and stratified across four timeframes: pre-pandemic, pandemic, post-pandemic, and normalization. Statistical analysis included descriptive evaluation and Poisson regression.

A total of 118,620 CMF-related diagnoses were recorded in the pre-pandemic period, which declined significantly during the pandemic (- 14.66%, p < 0.0001). Although case numbers increased in the post-pandemic (+ 4.95%, p < 0.0001) and normalization periods (+ 12.65%, p < 0.0001 compared to pandemic), they did not fully return to pre-pandemic levels. The largest relative declines were observed for mandibular and midfacial fractures. In contrast, general trauma indicators such as distal radius fractures remained relatively stable, suggesting a trauma-mechanism-specific effect.

The COVID-19 pandemic significantly reduced the number of CMF emergency cases in Germany, with partial recovery observed in subsequent years. These findings reflect shifts in trauma etiology and healthcare-seeking behavior during and after pandemic-related societal changes.