Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

Abstract

Concomitant maxillofacial and cervical spine injuries occur in 0.8–12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture. A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization. 7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1 and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.

Traumatic maxillofacial injuries: Patterns, outcomes, and long‐term follow‐up of a military cohort

“…Ruslin et al 37 found zygomatic fractures to be the most common sport‐related fracture, further emphasizing the need for further work‐up and perhaps long‐term follow‐up for the development of TBI and related complications among athletes with zygomatic fractures. The multivariable analysis strengthens previous findings, demonstrating that zygomatic fractures may be linked to brain injury 38 and cervical spine injury 39 . Zygomatic fractures presumably require high energy, as other facial fractures frequently accompany them 39 .…”

“…The multivariable analysis strengthens previous findings, demonstrating that zygomatic fractures may be linked to brain injury 38 and cervical spine injury. 39 Zygomatic fractures presumably require high energy, as other facial fractures frequently accompany them. 39 Błaszczyk et al 40 further demonstrated that craniocerebral injury is commonly observed in trauma mechanisms, including upper facial dislocation or extensive impact in the lateral face with involvement of the zygoma.…”

“…39 Zygomatic fractures presumably require high energy, as other facial fractures frequently accompany them. 39 Błaszczyk et al 40 further demonstrated that craniocerebral injury is commonly observed in trauma mechanisms, including upper facial dislocation or extensive impact in the lateral face with involvement of the zygoma. Finally, the findings may also be explained by the anatomic proximity of the zygoma and orbit with the temporal and frontal brain lobes.…”