Abstract
-
Objective
To use data from the National Trauma Registry of Iran (NTRI) to explore whether the type of traumatic facial fractures predicts intracranial lesions.
-
Methods
This retrospective registry-based study analyzed 6 years of data from four NTRI trauma centers, focusing on patients with facial fractures. Patients with at least one facial fracture were included, and data on demographics, injury mechanisms, fracture patterns, and intracranial lesions were analyzed. A multiple logistic regression model demonstrated the associations between clinical variables and intracranial lesions.
-
Results
Among 32,525 patients, 1,166 (3.6%) had facial fractures. Motorcycle riders had a higher probability of malar-maxillary fractures than mandibular fractures (P<0.001). Non–road traffic accident injuries were significantly associated with mandibular fractures compared to malar-maxillary fractures (P<0.001). Intracranial lesions were identified in 14.8% of patients, with subarachnoid hemorrhage (38.4%), subdural hemorrhage (19.8%), and epidural hemorrhage (18.6%) being the most common. Most intracranial lesions developed in patients with malar-maxillary fractures (n=82, 47.7%). Among the types of facial fractures, malar-maxillary fractures had the highest association with intracranial lesions (odds ratio [OR], 15.33; 95% confidence interval [CI], 6.57–35.79; P<0.001), and that finding remained significant after adjustment (adjusted OR, 7.20; 95% CI, 2.97–17.42; P<0.001).
-
Conclusion
Among patients with traumatic facial fractures, several fracture patterns were associated with intracranial lesions, with malar-maxillary fractures showing the strongest association. Careful evaluation for intracranial lesions is warranted in patients with high-risk facial fracture patterns.
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Keywords: Facial fracture; Intracranial lesion; Trauma
Capsule Summary
What is already known
Facial fractures are associated with intracranial injuries, which are a significant cause of morbidity and mortality. Although skull base fractures are known predictors of intracranial hemorrhage, the value of specific types of facial fractures, specifically midface fractures, for predicting intracranial lesions remains less explored.
What is new in the current study
This study identifies a significant association between facial fractures and a high risk of intracranial lesions, with malar-maxillary fractures posing the strongest risk. Road traffic accidents are the leading cause of such fractures. Intracranial lesions were most frequently observed in patients with malar-maxillary fractures, emphasizing the need for urgent clinical attention in such cases. The findings underscore the importance of a multidisciplinary approach to trauma care to improve patient outcomes.
INTRODUCTION
Facial fractures are a serious public health problem in both high- and low-income countries [
1–
3]. Although it was once thought that facial fractures acted to protect intracranial structures by absorbing impact forces, recent evidence suggests they actually increase the risk of intracranial injuries [
4–
8]. In addition, the complex anatomy of the facial skeleton often results in multiple fractures, increasing the risk of intracranial injury [
9]. Thus, patients with facial fractures are at significant risk for traumatic intracranial lesions, which are a leading cause of morbidity and mortality [
10]. Keenan et al. [
4] showed that the risk of serious intracranial lesions increases nearly tenfold in facial trauma patients. Rupture of intracranial vessels following a fracture of facial bones can lead to hemorrhages in various compartments [
10]. As a result, facial fractures should always raise clinical concern about associated brain damage because they can be a marker of substantial energy transfer to the brain [
9]. Immediate detection and decompression of intracranial hemorrhage can significantly reduce brain injury [
9].
Previous studies indicate that fractures of the cranial vault, basal skull, and midface strongly predict intracranial hemorrhage (ICH) [
1,
10–
13]. Mandibular, orbital, nasal, zygomatic, and maxillary fractures, along with cervical spine injuries, elevate the risk of ICH by two to four times [
10]. Approximately 10% of patients with craniomaxillofacial fractures, particularly those with central midface and skull base fractures, require urgent neurosurgical intervention due to ICH [
14]. Although the biomechanics of facial fractures and the force needed to fracture different facial bones are well documented in the literature [
15], few reports indicate the specific facial fractures predisposing patients to ICH [
9].
We hypothesized that mandibular fractures, malar-maxillary fractures, orbital floor fractures, nasal bone fractures, and multiple (≥2) facial fractures carry varying risks of intracranial lesions. To test that hypothesis, we obtained 6 years of data from the National Trauma Registry of Iran (NTRI) and explored distinctions among the types of traumatic facial fractures in predicting the occurrence of intracranial lesions.
METHODS
Ethics statement
This study was approved by the Ethics Committee of Sina Hospital, Tehran University of Medical Sciences (No. IR.TUMS.SINAHOSPITAL.REC.1399.090). All data were anonymized prior to analysis, with verbal consent obtained from patients or their next of kin.
Study design and setting
This retrospective registry-based study focused on patients with facial bone fractures. Data were obtained from four collaborating trauma centers of the NTRI, comprising Sina Hospital in Tehran, Shahid Rahnemoun Hospital in Yazd, Shahid Beheshti Hospital in Kashan, and Imam Khomeini Hospital in Urmia, covering the period from 7 October 2018 to 28 March 2024.
The NTRI is a hospital-based national trauma registry developed under the supervision of the Ministry of Health and Medical Education in 2014 and coordinated by the Sina Trauma and Surgery Research Center to improve trauma care and policymaking in Iran. At each center, trained registrars with a medical background are responsible for collecting patient data using a standardized minimum dataset (MDS) developed by a multidisciplinary panel of experts in trauma surgery, emergency medicine, epidemiology, or health information systems [
16]. The NTRI MDS includes detailed variables across domains such as demographics, injury mechanism, injury site and severity, prehospital care, emergency department data, in-hospital treatments, and outcomes. Data collection is performed by trained clinical registrars using structured protocols involving patient interviews, medical record reviews, and hospital information systems. International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes are assigned by certified coders and reviewed by senior reviewers and surgeons to ensure accuracy and consistency [
16,
17]. According to the NTRI, eligible cases must meet at least one of the following criteria [
16]: (1) hospital admission due to trauma; (2) hospital admission for longer than 24 hours; (3) death after hospital arrival; or (4) interhospital transfer within 24 hours after injury.
All patients who met the NTRI registration criteria and presented with at least one facial fracture (with or without concomitant nonfacial injuries) were included in this study [
16]. Additional inclusion criteria for this study involved documented evidence of fractures through clinical examination and the specific ICD-10 codes registered for each patient (S02.2, fracture of nasal bones; S02.3, fracture of orbital floor; S02.4, fracture of malar, maxillary, or zygoma bones; and S02.6, fracture of mandible). Patients who had ICD-10 codes related to unspecified facial bone fractures (S02.8, S02.9) were excluded to minimize diagnostic ambiguity, maintain internal validity, and ensure comparability across fracture types. Other studies have previously described the formation of the NTRI and its questionnaire [
17–
19].
In this study, missing data accounted for less than 2% of the total dataset. To ensure data integrity, we compared the baseline and clinical characteristics of patients with missing data and those included in the final analysis. No significant differences were found between the groups, suggesting that the exclusion of these patients did not result in any substantial differences in the study findings. Therefore, patients with missing values in any of the key variables were excluded from the analysis.
Data collection
Data were extracted from the NTRI database, and the patients were categorized into five groups based on facial fracture type: mandibular fracture, malar-maxillary fracture, orbital floor fracture, nasal bone fracture, and multiple (≥2) facial fractures.
The demographic variables of sex and age were assessed alongside injury mechanisms, severity, and patterns. The mechanisms of injury were classified as road traffic accident (RTA) and non-RTA, with detailed RTA subgroups of car drivers, car passengers, motorcycle riders, motorcycle pillion passengers, pedestrians, and other RTAs. The Injury Severity Score (ISS) was used to categorize injury severity into three groups (<9, 9–15, ≥16). Injury patterns were categorized as isolated or multiple traumas and further subdivided based on the number and regions of injuries sustained (cases that sustained injuries in two body regions and those that sustained injuries in more than two body regions). Patients with two injured body regions were also divided into the following groups: face + head, face + upper extremities, face + lower extremities, and face + any other body region.
Intracranial lesions were classified into seven groups [
20]: subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), epidural hemorrhage (EDH), SAH+SDH, SAH+EDH, SDH+EDH, and SAH+SDH+EDH. These categories were identified using ICD-10 codes: S06.4 for EDH, S06.5 for traumatic SDH, and S06.6 for traumatic SAH. We analyzed the three main in-hospital outcomes of intensive care unit (ICU) admission and mechanical ventilation, recorded as binary outcomes, and in-hospital mortality.
All statistical analyses were performed using Stata ver. 17.0 (Stata Corp). The nominal and categorical variables associated with the facial fracture types are described using numbers and percentages. The chi-square test was performed to assess the associations between nominal and categorical variables and facial fracture types, as well as those between injury outcomes and types of facial fractures. Where a significant overall difference was found across groups, post hoc pairwise comparisons were conducted using the Bonferroni correction to adjust for multiple testing and control for type I errors. A univariable logistic regression model was used to assess the predictors of any type of intracranial lesion. To create the adjusted model and control for potential confounding, covariates with a P-value of <0.2 in the univariable analysis were included in the multivariable logistic regression model. The Hosmer-Lemeshow test was performed to assess model fit. [
21]. Then, a likelihood ratio test was used to choose variables to remain in the model and those to exclude [
21]. A P-value of <0.05 was considered statistically significant.
RESULTS
Among 32,525 patients registered by the four NTRI collaborating centers, we analyzed data from 1,166 patients who sustained facial fractures. The frequencies of observed fracture types were nasal bone fractures in 333 patients (28.6%), malar-maxillary fractures in 312 patients (26.8%), mandibular fractures in 264 patients (22.6%), multiple facial fractures in 239 (20.5%), and orbital floor fractures in 18 (1.5%) (
Fig. 1). The cohort was predominantly male (n=996, 85.4%) and had a mean age of 34.2±17.4 years. The proportion of patients >65 years old with mandibular fracture was significantly lower than in the other groups (P=0.010). Patients differed significantly for ISS (P<0.001). Among patients with ISS ≥16, the proportion with a malar-maxillary fracture (n=59, 18.9%) was significantly higher than that of patients with nasal bone fractures (n=23, 6.9%; P<0.001). The primary mechanism of injury was RTA, which accounted for 873 cases (74.9%). Among those patients, motorcycle riders were the most affected subgroup, comprising 400 (34.3%) of the total population. In contrast, non-RTA injuries were significantly more frequent among patients with mandibular fractures than among those with malar-maxillary fractures (P<0.001) (
Table 1).
In terms of injury patterns, 169 patients (64.0%) with mandibular fractures suffered isolated trauma, a significantly larger number than those with any other type of facial fracture (P<0.001). The combination of facial and head injuries was the most common pattern of multiple traumas, affecting 285 cases (24.4%) and differing significantly among the mandibular, orbital floor, and nasal groups (P<0.001) (
Table 2).
Intracranial lesions were identified in 172 patients (14.8%), with SAH being the most prevalent type, occurring in 66 patients (38.4%), followed by SDH in 34 (19.8%), EDH in 32 (18.6%), SAH+SDH in 25 (14.5%), SAH+EDH in 7 (4.1%), SDH+EDH in 5 (2.9%), and SAH+SDH+EDH in 3 (1.7%) (
Table 3). The occurrence of each type of intracranial lesion was significantly higher in patients with orbital floor fractures or malar-maxillary fractures than in those with mandibular fractures (P<0.001).
For all three assessed in-hospital outcomes, patients with malar-maxillary fractures and those with multiple facial fractures significantly outnumbered those with mandibular fractures. The overall mortality rate was 4.4%. Notably, multiple facial fractures were significantly associated with increased mortality (P=0.003), ICU admission (P<0.001), and mechanical ventilation (P<0.001), emphasizing the severity of these injuries (
Table 4).
Malar-maxillary fractures were most strongly associated with intracranial lesions (odds ratio [OR], 15.33; 95% confidence interval [CI], 6.57–35.79), followed by orbital floor fractures (OR, 12.29; 95% CI, 3.11–48.58). Those associations remained significant after adjustment: malar-maxillary (adjusted OR [aOR], 7.20; 95% CI, 2.97–17.42) and orbital floor (aOR, 5.15; 95% CI, 1.17–22.76) (
Table 5).
DISCUSSION
A previous theory posited that facial fractures absorbed the forces from head trauma, safeguarding structures inside the skull [
4,
5]. However, Keenan et al. [
4] found no evidence to support the idea that facial fractures prevent traumatic brain injury (TBI). They noted that the risk of intracranial injury increased nearly tenfold in individuals with facial injuries. That does not mean that facial fractures cause TBI but indicates that a blunt impact force of a magnitude sufficient to break facial bones could also result in intracranial injury.
The literature lacks consensus about the prevalence of specific types of facial fractures. Some studies suggest that mandibular fractures are the most prevalent [
22–
25], and others, consistent with our findings, highlight the occurrence of nasal and mid-facial fractures [
26–
28].
In accordance with our findings, Kloss et al. [
13], who specifically analyzed ICH in facial fracture patients in 2008, reported a large proportion of men (73.7%). Also, in a study examining and contrasting the causes, patterns, sex distribution, and anatomical locations of mandibular fractures, Vyas et al. [
29] found that men were more frequently affected than women, with the highest occurrence rate observed in the 30–35-year age group. In the study of Dobitsch et al. [
30], the most frequent facial fractures in the older age population (defined as age ≥65 years) were the nasal bone (51.6%) and orbit (42.7%). Nineteen patients (22.6%) who were older than 65 years in our study had intracranial lesions, whereas Dobitsch et al. [
30] reported 41 (33.1%) with ICH.
In many low-income nations, RTAs are the primary cause of maxillofacial fractures [
31–
33]. In line with the population studied here, the primary cause of injury in Vyas et al. [
29] was RTA (45.3%), followed by falls (42.6%) and other causes (12.1%). Similar to our results, earlier studies noted that EDH had the lowest occurrence rate among the types of ICHs [
34,
35]. Also in line with the distribution of our cases, Kloss et al. [
13] revealed that, of 54 patients with intracranial lesions, 23 (42.6%) had SAHs, 18 (33.3%) had EDHs, and 15 (27.8%) had SDHs. Their study also indicated that 33 (61.1%) patients experienced only a single type of intracranial lesion, while 21 (38.9%) had multiple types. On the other hand, the predominant intracranial lesion in the study of Sandhya et al. [
9] was SDH, followed closely by epidural hematoma.
Among patients with ICH in our study, 82 (47.7%) had a malar-maxillary fracture, 36 (20.9%) had a nasal bone fracture, 6 (3.5%) had a mandibular fracture, 4 (2.3%) had an orbital floor fracture, and 44 (25.6%) had multiple (≥2) facial fractures. Kanno et al. [
11] revealed ICH in 17 patients (9.0%) with facial fractures: 11 (42.3%) with more than two facial fractures, 2 (11.8%) with mandibular fractures, 2 (11.8%) with alveolus fractures, 1 (5.9%) with a maxillary fracture, and 1 (5.9%) with a zygomatic fracture. In their multivariate logistic regression model, they concluded that sustaining >2 facial fractures was the strongest independent predictor of intracranial bleeding in maxillofacial fracture patients (OR, 19.1). In our study, on the other hand, although all types of facial fractures were significantly related to intracranial lesions, a malar-maxillary fracture was the strongest independent predictor of intracranial bleeding (aOR, 7.20). In the study conducted by Keenan et al. [
4], 81 patients sustained facial fractures, which comprised 31 mandibular fractures, 29 nasal fractures, 15 orbital fractures, and 6 maxillary fractures. Additionally, they revealed that the chance of intracranial injury in patients with facial fractures was 9.9 times higher than in other patients. In 2004, Hohlrieder et al. [
14] showed that fractures in the orbit and maxilla resulted in a twofold to threefold increase in the likelihood of ICH. Moreover, Zhou et al. [
36] found that RTAs were associated with a sixfold risk of head injury (OR, 6.2; 95% CI, 1.5–26.1; P=0.013). Patients with combined midface and mandible fractures were significantly more susceptible to head injuries (OR, 4.6; P<0.001) than those with multiple mandible fractures (P<0.001), a single mandibular fracture (P=0.017), or a single mandibular condylar fracture (P=0.019).
TBI encompasses various pathological conditions, including diffuse axonal injury, cerebral contusions, epidural hematoma, subdural hematoma, and SAH [
37]. McCarty et al. [
38] illustrated among trauma patients with specific facial fractures of isolated nasal, mandible, malar-maxillary, orbital floor, and alveolar or palate fractures that mild TBI varied from 21.3% in cases of mandibular fractures to 46.0% in alveolar or palate fractures. Moreover, the prevalence of moderate to severe TBI ranged from 7.3% with mandibular fractures to 18.4% in malar-maxillary fractures. In addition, when facial fractures coexisted with other facial or skull fractures, the general occurrence of mild TBI varied from 38.4% in nonisolated mandible fractures to 50.7% in nonisolated alveolar, palate, and orbital fractures, excluding the orbital floor. Also, the prevalence of moderate to severe TBI ranged from 20.3% in nonisolated orbital floor fractures to 27.4% in nonisolated mandible fractures. After adjustments, the likelihood of mild TBI and moderate to severe TBI was lowest in trauma patients with mandibular fractures alone, consistent with our findings.
Based on the results of a bivariate data analysis of mandibular fracture cases, Natigor et al. [
39] demonstrated no significant association of age and cause of injury with intracranial lesions when tested together.
Collaboration among trauma teams, emergency physicians, and surgical teams, particularly neurosurgeons, is crucial to promptly stabilize and treat patients with facial fractures [
40]. From the moment of admission, maxillofacial trauma surgeons and trauma teams need to be vigilant about the potential presence of an ICH in patients with maxillofacial fractures. They should prioritize a comprehensive screening that involves a head computed tomography scan and seek neurosurgical advice to promptly identify any ICH [
11].
Our study limitations are the retrospective design and the lack of detail in the NTRI, which hinders the precise identification of specific types of facial fractures, such as Le Fort fracture types. As a result, we did not know the exact location of each facial fracture. Another limitation is the lack of a control group of trauma patients without facial fractures, which limits our ability to compare the overall risk of intracranial lesions across the broader trauma population. In this study, we focused on patients with facial fractures, and our conclusions apply only to this subgroup and should be interpreted accordingly.
Conclusions
This study illustrates a significant relationship between type of traumatic facial fracture and intracranial lesions. Our findings suggest that, among facial fractures, a single malar-maxillary fracture poses the highest risk of intracranial lesions. Also, being injured in an RTA enhances the probability of facial fracture accompanied by an ICH compared with other injury mechanisms. The data collected from the NTRI over 6 years underscore the importance of considering intracranial lesions in patients diagnosed with facial fractures, particularly those presenting with malar-maxillary fractures. Further studies are warranted to enhance the understanding and treatment of such complex injuries and improve patient outcomes.
NOTES
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Author contributions
Conceptualization: PS, ZR, VB, VRM, ML, KN, MZ; Formal analysis: VB; Methodology: VB, VRM, EF, SHSB, YM, SMP, SM; Writing–original draft: ZR; Writing–review & editing: all authors. All authors read and approved the final manuscript.
-
Conflicts of interest
The authors have no conflicts of interest to declare.
-
Funding
This study was supported by a grant from the Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (No. 50495).
-
Acknowledgments
The authors extend their sincere appreciation to their colleagues at Sina Trauma and Surgery Research Center who played an active role in this study.
-
Data availability
Data analyzed in this study are available from the corresponding author upon reasonable request.
Fig. 1.Flow diagram of patient selection and classification of facial fractures. NTRI, National Trauma Registry of Iran; ICD-10, International Classification of Diseases, 10th Revision.
Table 1.Baseline characteristics of patients with facial fractures
Table 1.
|
Characteristic |
No. of patients (%) |
P-value |
|
Total (n=1,166) |
Mandibular fracture (n=264) |
Malar-maxillary fracture (n=312) |
Orbital floor fracture (n=18) |
Nasal bone fracture (n=333) |
Multiple (≥2) facial fractures (n=239) |
|
Sex |
|
|
|
|
|
|
0.045*
|
|
Male |
996 (85.4) |
217 (82.2)a)
|
268 (85.9)a),b)
|
15 (83.3)a),b)
|
278 (83.5)a),b)
|
218 (91.2)b)
|
|
|
Female |
170 (14.6) |
47 (17.8)a)
|
44 (14.1)a),b)
|
3 (16.7)a),b)
|
55 (16.5)a),b)
|
21 (8.8)b)
|
|
|
Age (yr) |
|
|
|
|
|
|
0.010*
|
|
<18 |
158 (13.6) |
43 (16.3)a)
|
43 (13.8)a)
|
4 (22.2)a)
|
37 (11.1)a)
|
31 (13.0)a)
|
|
|
18–65 |
924 (79.2) |
215 (81.4)a)
|
239 (76.6)a)
|
12 (66.7)a)
|
274 (82.3)a)
|
184 (77.0)a)
|
|
|
>65 |
84 (7.2) |
6 (2.3)a)
|
30 (9.6)b)
|
2 (11.1)a),b)
|
22 (6.6)a),b)
|
24 (10.0)b)
|
|
|
Injury Severity Score |
|
|
|
|
|
|
<0.001*
|
|
<9 |
681 (58.4) |
216 (81.8)a)
|
143 (45.8)b)
|
8 (44.4)b),c)
|
219 (65.8)c)
|
95 (39.7)b)
|
|
|
9–15 |
341 (29.2) |
38 (14.4)a)
|
110 (35.3)b),c)
|
6 (33.3)a),b),c)
|
91 (27.3)c)
|
96 (40.2)b)
|
|
|
≥16 |
144 (12.4) |
10 (3.8)a)
|
59 (18.9)b)
|
4 (22.2)b),c)
|
23 (6.9)a),c)
|
48 (20.1)b)
|
|
|
Mechanism of injury |
|
|
|
|
|
|
<0.001*
|
|
RTA |
|
|
|
|
|
|
|
|
Car driver |
116 (9.9) |
25 (9.5)a)
|
25 (8.0)a)
|
0 (0)a)
|
41 (12.3)a)
|
25 (10.5)a)
|
|
|
Car passenger |
149 (12.8) |
34 (12.9)a)
|
34 (10.9)a)
|
2 (11.1)a)
|
50 (15.0)a)
|
29 (12.1)a)
|
|
|
Motorcycle rider |
400 (34.3) |
62 (23.5)a)
|
130 (41.7)b)
|
7 (38.9)a),b)
|
94 (28.2)a)
|
107 (44.8)b)
|
|
|
Motorcycle pillion passenger |
34 (2.9) |
2 (0.8)a)
|
10 (3.2)a)
|
0 (0)a)
|
15 (4.5)a)
|
7 (2.9)a)
|
|
|
Pedestrian |
62 (5.3) |
13 (4.9)a)
|
12 (3.8)a)
|
1 (5.6)a)
|
22 (6.6)a)
|
14 (5.9)a)
|
|
|
Other |
112 (9.6) |
20 (7.6)a)
|
30 (9.6)a)
|
2 (11.1)a)
|
38 (11.4)a)
|
22 (9.2)a)
|
|
|
Non-RTA |
293 (25.1) |
108 (40.9)a)
|
71 (22.8)b)
|
6 (33.3)a),b)
|
73 (21.9)b)
|
35 (14.6)b)
|
|
Table 2.Injury pattern in patients with facial fractures
Table 2.
|
Injury pattern |
No. of patients (%) |
P-value |
|
Total (n=1,166) |
Mandibular fracture (n=264) |
Malar-maxillary fracture (n=312) |
Orbital floor fracture (n=18) |
Nasal bone fracture (n=333) |
Multiple (≥2) facial fractures (n=239) |
|
Isolated trauma |
375 (32.2) |
169 (64.0)a)
|
78 (25.0)b)
|
1 (5.6)b)
|
80 (24.0)b)
|
47 (19.7)b)
|
<0.001 |
|
Multiple trauma |
|
|
|
|
|
|
|
|
Face + head |
285 (24.4) |
21 (8.0)a)
|
112 (35.9)b)
|
7 (38.9)b),c)
|
65 (19.5)c)
|
80 (33.5)b)
|
<0.001 |
|
Face + upper extremities |
55 (4.7) |
11 (4.2)a),b),c)
|
7 (2.2)c)
|
1 (5.6)a),b),c)
|
32 (9.6)b)
|
4 (1.7)a),c)
|
<0.001 |
|
Face + lower extremities |
52 (4.5) |
15 (5.7)a),b)
|
3 (1.0)c)
|
1 (5.6)a),b),c)
|
27 (8.1)b)
|
6 (2.5)a),c)
|
<0.001 |
|
Face + any other body region |
27 (2.3) |
7 (2.7)a)
|
5 (1.6)a)
|
1 (5.6)a)
|
10 (3.0)a)
|
4 (1.7)a)
|
0.592 |
|
>2 Body regions |
372 (31.9) |
41 (15.5)a)
|
107 (34.3)b)
|
7 (38.9)a),b)
|
119 (35.7)b)
|
98 (41.0)b)
|
<0.001 |
Table 3.Association between type of facial fracture and intracranial lesions
Table 3.
|
Intracranial lesion |
No. of patients (%) |
P-value |
|
Total (n=172) |
Mandibular fracture (n=6) |
Malar-maxillary fracture (n=82) |
Orbital floor fracture (n=4) |
Nasal bone fracture (n=36) |
Multiple (≥ 2) facial fractures (n=44) |
|
SAH |
66 (38.4) |
4 (66.7)a)
|
26 (31.7)b)
|
2 (50.0)a),b)
|
14 (38.9)a),b)
|
20 (45.5)b)
|
0.001*
|
|
SDH |
34 (19.8) |
2 (33.3)a)
|
18 (22.0)b)
|
0 (0)a),b)
|
5 (13.9)a)
|
9 (20.5)a),b)
|
0.002*
|
|
EDH |
32 (18.6) |
0 (0)a)
|
14 (17.1)b)
|
1 (25.0)b)
|
10 (27.8)b)
|
7 (15.9)a),b)
|
0.020*
|
|
SAH+SDH |
25 (14.5) |
0 (0)a)
|
12 (14.6)b)
|
0 (0)a),b)
|
6 (16.7)a),b)
|
7 (15.9)a),b)
|
0.023*
|
|
SAH+EDH |
7 (4.1) |
0 (0)a)
|
5 (6.1)a),b)
|
1 (25.0)b)
|
0 (0)a)
|
1 (2.3)a),b)
|
0.003*
|
|
SDH+EDH |
5 (2.9) |
0 (0)a)
|
4 (4.9)a)
|
0 (0)a)
|
1 (2.8)a)
|
0 (0)a)
|
0.104 |
|
SAH+SDH+EDH |
3 (1.7) |
0 (0)a)
|
3 (3.7)a)
|
0 (0)a)
|
0 (0)a)
|
0 (0)a)
|
0.083 |
Table 4.Association between type of facial fracture and in-hospital outcomes
Table 4.
|
Variable |
No. of patients (%) |
P-value |
|
Total (n=1,166) |
Mandibular fracture (n=264) |
Malar-maxillary fracture (n=312) |
Orbital floor fracture (n=18) |
Nasal bone fracture (n=333) |
Multiple (≥2) facial fractures (n=239) |
|
ICU admission |
|
|
|
|
|
|
<0.001*
|
|
Yes |
303 (26.0) |
31 (11.7)a)
|
107 (34.3)b)
|
6 (33.3)a),b)
|
64 (19.2)a)
|
95 (39.7)b)
|
|
|
No |
863 (74.0) |
233 (88.3)a)
|
205 (65.7)b)
|
12 (66.7)a),b)
|
269 (80.8)a)
|
144 (60.3)b)
|
|
|
Mechanical ventilation |
|
|
|
|
|
|
<0.001*
|
|
Yes |
152 (13.0) |
19 (7.2)a)
|
59 (18.9)b)
|
2 (11.1)a),b)
|
22 (6.6)a)
|
50 (20.9)b)
|
|
|
No |
1,014 (87.0) |
245 (92.8)a)
|
253 (81.1)b)
|
16 (88.9)a),b)
|
311 (93.4)a)
|
189 (79.1)b)
|
|
|
Discharge status |
|
|
|
|
|
|
0.003*
|
|
Died |
51 (4.4) |
3 (1.1)a)
|
23 (7.4)b)
|
1 (5.6)a),b)
|
10 (3.0)a),b)
|
14 (5.9)b)
|
|
|
Survived |
1,115 (95.6) |
261 (98.9)a)
|
289 (92.6)b)
|
17 (94.4)a),b)
|
323 (97.0)a),b)
|
225 (94.1)b)
|
|
Table 5.Logistic regression analysis of factors associated with intracranial lesions among patients with facial fractures (n=1,166)
Table 5.
|
Variable |
Intracranial lesion |
Univariable analysis |
Multivariable analysis |
|
Yes (n=172) |
No (n=994) |
OR (95% CI) |
P-value |
aOR (95% CI) |
P-value |
|
Type of facial fracture |
|
|
|
|
|
|
|
Mandibular fracture |
6 (3.5) |
258 (26.0) |
1 (Reference) |
|
1 (Reference) |
|
|
Malar-maxillary fracture |
82 (47.7) |
230 (23.1) |
15.33 (6.57–35.79) |
<0.001*
|
7.20 (2.97–17.42) |
<0.001*
|
|
Orbital floor fracture |
4 (2.3) |
14 (1.4) |
12.29 (3.11–48.58) |
<0.001*
|
5.15 (1.17–22.76) |
0.031*
|
|
Nasal bone fracture |
36 (20.9) |
297 (29.9) |
5.21 (2.16–12.57) |
<0.001*
|
3.56 (1.43–8.90) |
0.007*
|
|
Multiple (≥2) facial fractures |
44 (25.6) |
195 (19.6) |
9.70 (4.05–23.23) |
<0.001*
|
3.63 (1.46–9.02) |
0.006*
|
|
Age (yr) |
|
|
|
|
|
|
|
<18 |
22 (12.8) |
136 (13.7) |
1 (Reference) |
|
|
|
|
18–65 |
131 (76.2) |
793 (79.8) |
1.02 (0.63–1.66) |
0.933 |
|
|
|
>65 |
19 (11.0) |
65 (6.5) |
1.81 (0.91–3.57) |
0.089 |
|
|
|
Sex |
|
|
|
|
|
|
|
Male |
151 (87.8) |
845 (85.0) |
1 (Reference) |
|
|
|
|
Female |
21 (12.2) |
149 (15.0) |
0.79 (0.48–1.29) |
0.341 |
|
|
|
Injury Severity Score |
|
|
|
|
|
|
|
<9 |
15 (8.7) |
666 (67.0) |
1 (Reference) |
|
1 (Reference) |
|
|
9–15 |
97 (56.4) |
244 (24.5) |
17.65 (10.05–31.0) |
<0.001*
|
14.68 (8.29–26.01) |
<0.001*
|
|
≥16 |
60 (34.9) |
84 (8.5) |
31.71 (17.24–58.35) |
<0.001*
|
24.39 (13.05–45.58) |
<0.001*
|
|
Mechanism of injury |
|
|
|
|
|
|
|
RTA |
147 (85.5) |
726 (73.0) |
1 (Reference) |
|
|
|
|
Non-RTA |
25 (14.5) |
268 (27.0) |
0.46 (0.29–0.72) |
0.001*
|
|
|
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, Payman Salamati1
