Skip to main content

Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis.

Publication ,  Journal Article
Bellamy, JL; Mundinger, GS; Flores, JM; Reddy, SK; Mithani, SK; Rodriguez, ED; Dorafshar, AH
Published in: J Craniofac Surg
November 2013

PURPOSE: The aim of this article was to assess how regional facial fracture patterns predict mortality and occult intracranial injury after blunt trauma. METHODS: Retrospective chart review was performed for blunt-mechanism craniofacial fracture patients who presented to an urban trauma center from 1998 to 2010. Fractures were confirmed by author review of computed tomographic imaging and then grouped into 1 of 5 patterns of regional involvement representing all possible permutations of facial-third injury. Mortality and the presence of occult intracranial injury, defined as those occurring in patients at low risk at presentation for head injury by Canadian CT Head Rule criteria, were evaluated. Relative risk estimates were obtained using multivariable regression. RESULTS: Of 4540 patients identified, 338 (7.4%) died, and 171 (8.1%) had intracranial injury despite normal Glasgow Coma Scale at presentation. Cumulative mortality reached 18.8% for isolated upper face fractures, compared with 6.9% and 4.0% for middle and lower face fractures (P < 0.001), respectively. Upper face fractures were independently associated with 4.06-, 3.46-, and 3.59-fold increased risk of death for the following fracture patterns: isolated upper, combined upper, panfacial, respectively (P < 0.001). Patients who were at low risk for head injury remained 4 to 6 times more likely to suffer an occult intracranial injury if they had involvement of the upper face. CONCLUSIONS: The association between facial fractures, intracranial injury, and death varies by regional involvement, with increasing insult in those with upper face fractures. Cognizance of the increased risk for intracranial injury in patients with upper face fractures may supplement existing triage tools and should increase suspicion for underlying or impending neuropathology, regardless of clinical picture at presentation.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Craniofac Surg

DOI

EISSN

1536-3732

Publication Date

November 2013

Volume

24

Issue

6

Start / End Page

1922 / 1926

Location

United States

Related Subject Headings

  • Young Adult
  • Wounds, Nonpenetrating
  • White People
  • Urban Health
  • Tomography, X-Ray Computed
  • Skull Fractures
  • Risk
  • Retrospective Studies
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bellamy, J. L., Mundinger, G. S., Flores, J. M., Reddy, S. K., Mithani, S. K., Rodriguez, E. D., & Dorafshar, A. H. (2013). Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis. J Craniofac Surg, 24(6), 1922–1926. https://doi.org/10.1097/SCS.0b013e3182a30544
Bellamy, Justin L., Gerhard S. Mundinger, José M. Flores, Sashank K. Reddy, Suhail K. Mithani, Eduardo D. Rodriguez, and Amir H. Dorafshar. “Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis.J Craniofac Surg 24, no. 6 (November 2013): 1922–26. https://doi.org/10.1097/SCS.0b013e3182a30544.
Bellamy JL, Mundinger GS, Flores JM, Reddy SK, Mithani SK, Rodriguez ED, et al. Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis. J Craniofac Surg. 2013 Nov;24(6):1922–6.
Bellamy, Justin L., et al. “Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis.J Craniofac Surg, vol. 24, no. 6, Nov. 2013, pp. 1922–26. Pubmed, doi:10.1097/SCS.0b013e3182a30544.
Bellamy JL, Mundinger GS, Flores JM, Reddy SK, Mithani SK, Rodriguez ED, Dorafshar AH. Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis. J Craniofac Surg. 2013 Nov;24(6):1922–1926.

Published In

J Craniofac Surg

DOI

EISSN

1536-3732

Publication Date

November 2013

Volume

24

Issue

6

Start / End Page

1922 / 1926

Location

United States

Related Subject Headings

  • Young Adult
  • Wounds, Nonpenetrating
  • White People
  • Urban Health
  • Tomography, X-Ray Computed
  • Skull Fractures
  • Risk
  • Retrospective Studies
  • Middle Aged
  • Male