The facial skeleton: Armor to the brain?

Abstract

Background:With the development of urban setting worldwide, the major issue of concern is the increase in the mortality rate in the population due to road traffic accidents. The face, being the most exposed region is susceptible to injuries and maybe associated with injuries to the adjacent neuro-cranium. The literature has conflicting views on the relationship between facial fractures and head injuries with some authors opining that the facial skeleton cushions the brain while some other authors claim that the facial fractures act as indicators for head injuries.Objectives:To analyze the correlation between the facial fractures and head injuries and to assess if the facial skeleton acts to protect the brain from injury.Patients and Methods:A prospective study that included patients who reported to the emergency department of Basaveswar Teaching and General Hospital, Gulbarga, during 2 years, between August 2013 and July 2015 was conducted. A total of 100 patients with facial fractures were enrolled in the study.Results:Head injuries were sustained by 51 patients in the study. Maximum number of patients was in the age group of 20–29 with a male to female ratio of 10.1:1. The mandible was the most frequently fractured bone in the facial skeleton followed by the zygomatico-maxillary complex. A majority (96%) of patients with head injuries had fractures of either the upper third or the middle third of the face. Contusions and pneumocephalus were the most common head injury encountered. The Glasgow Coma Scale score was significantly lower in patients with associated head injuries as compared to those patients with facial trauma alone. The mortality rate in the study was 2% with both the victims having sustained middle third and upper third fractures respectively with associated head injuries.Conclusion:The facial skeleton does not act to cushion the brain from injury but, in fact, the facial trauma victims should be considered potential head injury patients.

Medico-legal evaluation and trend of the different patterns of maxillofacial fractures concomitant with closed head injury in Upper Egypt: retrospective study

“…The epidemiological criteria revealed that maxillofacial fractures accounted for 4% of all trauma cases, and its peak was at the year 2011 and 2015; this result is slightly higher than that reported by Pillay et al which reported the incidence of craniomaxillofacial fractures as 2.9% (Pillay et al 2018), but lower than that previously reported (16%) in a similar study conducted in Australia (Shahim et al 2006). The incidence of traumatic head injury (THI) associated with MFF in different countries around the world is greatly different, but the overall result is higher in males when compared with females; in the present study, it is 7:1; this result is in accordance with Patil et al (2016). Other studies in the developed countries, the male/female ratio ranged from 2:1 to 4:1, which indicates the active participation of women in outdoor life activities than in developing countries (Gassner et al 2003).…”

Associated Injuries Are Frequent and Severe Among Geriatric Patients With Zygomatico-Orbital Fractures

“…9,10 Of the different types of brain injury, an association between ZMO fractures and subdural hematomas (SDHs) has been identified in the literature, 11 and brain injury frequencies of up to 61.0 to 67.0% have been reported in patients diagnosed with ZMO fractures. 12,13 The literature has clearly focused on the need for surgical intervention in ZMO fractures, and the authors are not aware of comparative publications focusing on the relation between AIs and ZMO fractures in geriatric patients with facial trauma.…”

Relationship of the Severity of Maxillofacial Trauma Based on Facial Injury Severity Scale (FISS) Against the Severity of Head Injury

“…FISS> 5 has a 18-fold longer predictive value, need for internal fixation, and multiprofession-related interventions FISS has more multitrauma faces and intracranial lesions that require surgical protection. 30,31 The results of the study by Nasser F have an important relationship between FISS scores with surgery. Research by Aita and colleagues, also stated that patients with a FISS score> 5…”

“…29 Whereas male gender is dominant than female, namely (4: 1) while Bagheri SC et al with a ratio (3: 1) because workers are dominated by men rather than women. Men have physical activity and are often involved in violence 30 . In terms of work, women work a lot at home, but if women's work is the same as men's work, then women can have this risk.…”