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2008 Annual Meeting Abstracts

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Predictable Patterns of Intracranial and Cervical Spine Injury in Craniomaxillofacial Trauma: Analysis of 4,786 Patients
Suhail K. Mithani, MD1, Hugo St-Hilaire, DDS, MD1, Rachel Bluebond-Langner, MD1, Benjamin S. Brooke, MD1, Ian M. Smith, MD1, Paul N. Manson, MD1, Eduardo D. Rodriguez, DDS, MD2.
1Johns Hopkins Medical Institutions, Baltimore, MD, USA, 2R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.

PURPOSE: Patients presenting with traumatic craniofacial fractures have multisystem patterns of injury which are difficult to diagnose. Concomitant injuries may be predicted by patterns of facial fractures due to consistent paths of force dispersion by the craniofacial skeleton. This study evaluates the association of craniofacial fractures with cervical spine and intracranial injuries.

METHODS: The medical records and imaging studies of patients diagnosed with maxillofacial fractures at a dedicated urban trauma center from 1998-2005 were retrospectively reviewed under an IRB approved protocol. Maxillofacial fractures and cervical spine injuries were grouped anatomically by dividing the craniofacial skeleton and cervical spine into upper, middle, and lower thirds. Univariate and multivariate logistic regression analysis was used to identify associations between facial fractures and concominant injuries.

RESULTS: 4,786 patients were identified with maxillofacial fractures. A total of 461(9.3%) patients had cervical spine injuries and 2175 (45.5%) patients had associated intracranial injuries. 333 (7.0%) patients died as a result of their injuries. Statistically significant associations were found between fractures of the upper face and mid- and lower-cervical spine injuries as well as a variety of intracranial injuries. Unilateral mandible injuries were associated with upper cervical spine injuries. Unilateral midface injuries were associated with basilar skull fractures, subarachnoid hemorrhage and subdural hematoma. Bilateral midface injuries were associated with basilar skull fracture (See Table).

CONCLUSION: Certain patterns of maxillofacial fractures are associated with specific constellations of intracranial and cervical spine injuries that appear to result from predictable patterns of force dispersion and transmission by the maxillofacial skeleton to the cranial vault and cervical spine. Occult trauma in patients with facial fractures may be expediently diagnosed by awareness of these associated injury patterns. This underscores the importance of an early evaluation by a multidisciplinary trauma team in patients with complex maxillofacial injuries.

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