The Relationship between Facial Fractures and Radiologically-proven Cranial Injuries

안면부 골절과 전산화 단층 촬영으로 진단된 두부 손상의 연관성

  • Song, Jin Woo (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University) ;
  • Jo, Ik Joon (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University) ;
  • Han, Sang Kook (Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University) ;
  • Jeong, Yeon Kwon (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University)
  • 송진우 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 조익준 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 한상국 (강북삼성병원 응급의학과) ;
  • 정연권 (성균관대학교 의과대학 삼성서울병원 응급의학과)
  • Received : 2009.02.28
  • Accepted : 2009.06.07
  • Published : 2009.06.30

Abstract

Purpose: In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries. Methods: Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs. Results: Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures. Conclusion: Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.

Keywords

References

  1. Lamberg MA, Tasanen A, Kotilainen R. Injuries concomitant with fractures of the facial skeleton. Proc Finn Dent Soc 1976;72:170-6
  2. Luce EA, Tubb TD, Moore AM. Review of 1000 major facial fractures and associated injuries. Plast Reconstr Surg 1979;63:26-30 https://doi.org/10.1097/00006534-197901000-00005
  3. Haug RRH, Prather J, Indresano AT. An An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 1990;48:926-32 https://doi.org/10.1016/0278-2391(90)90004-L
  4. Lim LH, Lam LK, Moore MH, Trott JA, David DJ. Associated injuries in facial fractures: review of 839 patients. Br J Plast Surg 1993;46:635-8 https://doi.org/10.1016/0007-1226(93)90191-D
  5. Alvi A, Doherty T, Lewen G. Facial fractures and concomitant injuries in trauma patients. Laryngoscope 2003;113:102-6 https://doi.org/10.1097/00005537-200301000-00019
  6. Yoo JH, Lee JK, Choi JP, Park JS. A study of facial fracture and associated injuries. J Korean Soc Emerg Med 2004;15:88-94
  7. Sinclair D, Schwartz M, Gruss J, McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med 1988;6:109-12 https://doi.org/10.1016/0736-4679(88)90148-5
  8. Davidoff G, Jakubowski M, Thomas D, Alpert M. The spectrum of closed-head injuries in facial trauma victims: Incidence and impact. Ann Emerg Med 1988;17:6-9
  9. Haug RH, Savage JD, Likavec MJ, Conforti PJ. A review of 100 closed head injuries associated with facial fractures. J Oral Maxillofac Surg 1992;50:218-22 https://doi.org/10.1016/0278-2391(92)90315-Q
  10. Haug RH, Adams JM, Conforti PJ, Likavec MJ. Cranial fractures associated with facial fractures: A review of mechanism, type, and severity of injury. J Oral Maxillofac Surg 1994;52:729-33 https://doi.org/10.1016/0278-2391(94)90488-X
  11. Keenan HT, Brundage SI, Thompson DC, Maier RV, Rivara FP. Does the face protect the brain? A casecontrol study of traumatic brain injury and facial fractures. Arch Surg 1999;134:14-7 https://doi.org/10.1001/archsurg.134.1.14
  12. Martin RC, Spain DA, Richardson JD. Do facial frac-tures protect the brain or are they a marker for severe head injury? Am Surg 2002;68:477-81
  13. Pappachan B, Alexander M. Correlating facial fractures and cranial injuries. J Oral Maxillofac Surg 2006;64:1023-9 https://doi.org/10.1016/j.joms.2006.03.021
  14. Lee KF, Wagner LK, Lee YE, Suh JH, Lee SR. The impact-absorbing effects of facial fractures in closedhead injuries. J Neurosurg 1987;66:542-7 https://doi.org/10.3171/jns.1987.66.4.0542
  15. Lee SW, Cho SJ, Ryu SY, Lee SL, Kim SE, Kim SJ. Correlation between facial fracture and cranial injury. J Korean Soc Traumatol 2006;19:150-8
  16. Hogg NJ, Stewart TC, Armstrong JE, Girotti MJ. Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada, between 1992 and 1997. J Trauma 2000;49:425-32 https://doi.org/10.1097/00005373-200009000-00007
  17. Hampson D. Facial injury: a review of biomechanical studies and test procedures for facial injury assessment. J Biomech 1995;28:1-7 https://doi.org/10.1016/0021-9290(95)80001-8
  18. Nahum AM. The biomechanics of maxillofacial trauma. Clin Plast Surg 1975;2:59-64
  19. Swearingen JJ. Tolerances of the human face to crash impact. Oklahoma City: Office of Aviation Medicine, Federal Aviation Agency 1965
  20. Haydel MJ, Shembekar AD. Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med 2003;42:507-14 https://doi.org/10.1067/S0196-0644(03)00512-2
  21. Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ, et al. Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? Pediatrics 2004;113:e507-13 https://doi.org/10.1542/peds.113.6.e507
  22. Montovani JC, de Campos LM, Gomes MA, de Moraes VR, Ferreira FD, Nogueira EA. Etiology and incidence facial fractures in children and adults. Rev Bras Otorrinolaringol 2006;72:235-41 https://doi.org/10.1590/S0034-72992006000200014
  23. Shapiro AJ, Johnson RM, Miller SF, McCarthy MC. Facial fractures in a level I trauma centre: the importance of protective devices and alcohol abuse. Injury 2001;32:353-6 https://doi.org/10.1016/S0020-1383(00)00245-X
  24. Dolan KD, Jacoby CG. Facial fractures. Semin Roentgenol 1978;13:37-51 https://doi.org/10.1016/S0037-198X(78)80017-0
  25. Matras H, Kuderna H. Combined cranio-facial fractures. J Maxillofac Surg 1980;8:52-9 https://doi.org/10.1016/S0301-0503(80)80072-5