Cervical Spine Fractures Associated With Maxillofacial Trauma

Abstract

Although cervical spine injury is rarely associated with maxillofacial trauma, it should be suspected when injuries above the clavicle occur, as suggested in the Advanced Trauma Life Support Manual. A retrospective study of 2482 patients with maxillofacial trauma, who were admitted to the Maxillofacial Surgical Division of Turin University between 1996 and 2006, conducted to identify concomitant fractures of the cervical spine and establish a treatment protocol. Twenty-one patients (0.8%), consisting of 17 males and four females ranging in age from 15 to 70 years, had amyelic cervical spine fractures. In 90% of the cases, the cervical spine injury was caused by a road accident. Cervical spine injuries were diagnosed using lateral x-rays in three cases and with computed tomography in the remaining patients. Although an association has been reported between mandibular fracture and cervical spine injury, we did not observe a preferential association between injuries of the upper third of the face and spinal injury. Cervical spine immobilization should never be removed until cervical spine injury has been excluded using a lateral x-ray of the cervical spine. In males with significant blunt craniomaxillofacial trauma caused by high-energy impact accidents such as car and motorcycle accidents, computed tomography is the radiologic examination of first choice to exclude cervical spine injuries. Lastly, the presence of a cervical spine injury did not result in modified or delayed treatment of maxillofacial fractures, with the exception of one patient who had a fracture of the odontoid process.

Age and Number of Surgeries Increase Risk for Complication in Polytrauma Patients with Operative Maxillofacial Fractures

“…Similar to previous reports [25][26][27][28]. We found associated injuries including intracranial hemorrhage (16.4%), skull fractures (23.7%), and spinal fractures (12.1%).…”

“…Rates of associated injuries vary from 1.9-19% for skull fractures [19,26,[29][30][31][32]. 11.0% to 43.7% for brain injury [9,24] and 0.8-24% for cervical spine injury [27,28,33]. The relative lack of protection of the head and neck in these high-impact settings make the face vulnerable to injury [34].…”

A review of cervical spine injury associated with maxillofacial trauma at a UK tertiary referral centre

“…[5][6][7][8] The majority of cohort studies have reported wide variations in the incidence of CSI in maxillofacial trauma patients, ranging between 0% and 8%, in part owing to differences in the mechanism of injury, anatomical location of impact, location of trauma centre, and patient demographics including age and sex. [1][2][3][4][7][8][9][10][11][12][13][14][15][16] In specific subgroups of patients such as RTA fatalities, the incidence of CSI has been cited as high as 24%. 9 Trauma protocols including the Advanced Trauma Life Support ® manual stress the importance of the association between maxillofacial injury and CSI, and the catastrophic consequences that can ensue if the diagnosis is missed or its presence or absence ignored.…”

Pentaplegia and Facial Bone Fracture: A Survivable Injury

“…Unfortunately, our patient did not recover any of his functions, but he survived a lethal injury. Roccia et al [5] 2482 patients with maxillofacial trauma 0.85% had amyelic cervical spine fractures Elahi et al [22] 3356 patients with craniomaxillofacial fractures 3.69% had CSI and increased to 8.86% with multiple facial fractures Mithani et al [23] 4786 patients with maxillofacial fractures 9.63% had CSI Mulligan et al [7] 117417 facial fractures 6.7% had CSI and increased to 7.8% with combined facial fracture and head injury Mulligan et al [8] 148478 facial fractures 4.9-8.0% had CSI for different single facial fractures and 7.0-10.8% had CSI with two or more facial fractures …”

“…However, even in the absence of above mentioned factors, spine immobilization should be applied until lateral cervical spine X-ray is negative [4]. The American College of Surgeons suggests high risk of CSI with injuries above the clavicle level [5]; others do not agree with this correlation [6]. We reviewed the medical literature using cervical spine injury, face trauma and related terminologies for such correlation studies and found ten relevant studies ( Table 1).…”