Facial Injury Severity Scale and Frontal-Segment Involvement as Risk Stratification Markers in Panfacial Fractures: A...

Panfacial fractures are high-energy injuries. We evaluated whether the Facial Injury Severity Scale (FISS) and frontal-segment involvement are associated with early surgical complications, length of stay, intensive care unit (ICU) admission, and craniocerebral injury. Thirty-four panfacial fracture patients treated between January 2016 and May 2026 were analyzed retrospectively at a single center. Fractures were classified with the Erdmann-Follmar four-segment model (≥3 of 4 segments); FISS used the Duke modified system. Because several tables were sparse, associations were estimated by Firth penalized logistic regression with profile penalized-likelihood confidence intervals (CIs), unadjusted and FISS-adjusted. Twenty-seven men and 7 women were included (mean age 37.2±18.6); the frontal-upper midface-lower midface pattern was commonest (38.2%), and median FISS was 13.5 (IQR 9-21). Concomitant injury occurred in 73.5% (craniocerebral 44.1%), early complications in 50.0%, and ICU admission in 52.9%. Frontal-segment involvement was associated with craniocerebral injury [odds ratio (OR) 7.14, 95% CI 1.31-74.4; P=0.021] and intracranial pathology (OR 17.59, 95% CI 1.88-2356.2; P=0.008); both were unchanged after adjustment for FISS, which showed no independent association with either. Conversely, FISS was independently associated with early surgical complications (OR 1.13 per point, 95% CI 1.01-1.27; P=0.028), whereas frontal involvement was not. The FISS ≥ 11 threshold was not validated. The 2 markers appear to index different axes of injury, but in 34 patients, CIs are wide, subgroup analyses are underpowered, and the composite craniocerebral association is partly definitional; these findings are hypothesis-generating and require multicenter validation.