Maxillofacial injuries in the multiply injured

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Maxillofacial Surgery

Background:

• Maxillofacial injuries (MFI) are common in multiply injured patients.
• Some patients require advanced airway management even after initial scene intubation.
• Severe MFI often co-occurs with other life-threatening injuries.

Purpose of the Study:

• To establish a database for patients with MFI and multiple injuries.
• To gather evidence supporting early definitive management of complex MFI cases.
• To challenge traditional expectant management policies for MFI.

Main Methods:

• Survey of 802 multiply injured patients evacuated by helicopter emergency medical services (HEMS).
• Analysis of injury severity scores (ISS) for facial and other regions.
• Review of interventions including airway management, laparotomy, thoracotomy, craniotomy, and orthopaedic surgery.

Main Results:

• 196 patients (24.5%) sustained MFI; 90 (11.2%) had severe MFI (ISS > 2).
• Severe MFI was associated with high overall ISS (median 36) and mortality (5.1%).
• Commonly associated injuries included orthopaedic (46%), abdominal (29% diagnostic peritoneal lavage), thoracic (15% chest drains), and cranial (9% craniotomies).

Conclusions:

• Delayed management of MFI can lead to uncorrectable facial deformities.
• Early definitive management strategies are needed for complex MFI cases.
• A comprehensive database is essential for advancing MFI treatment evidence.