The spectrum of facial fractures in motor vehicle accidents: an MDCT study of 374 patients

Abstract

Road traffic accidents are a major health problem worldwide resulting frequently in maxillofacial injuries. The purpose of the study was to assess the incidence and spectrum of facial fractures in patients involved in a motor vehicle accident (MVA). Using picture archiving and communication system, all requests for suspected facial trauma were retrieved during a 62-month period; 374 met the inclusion criteria. Two researchers interpreted the multidetector computed tomography images by consensus. The motor vehicles involved were divided into two groups: those involving a passenger car or a larger vehicle and those involving a motorized two-wheeler. Furthermore, the motor vehicle accidents were divided into collisions and run-off-road accidents. Of the 374 patients (aged 15-80, mean 34), 271 (72 %) were male and 103 (28 %) female. Of all patients, 262 (70 %) had a facial or skull base fracture; of these, multiple separate fractures were present in 56 %. Nasal fractures were the most common fractures followed by orbital, skull base, and maxillary fractures. Frontal bone, LeFort, and zygomatic arch fractures were always accompanied by other fractures. Fractures were more frequent in the group of collisions compared with run-off-road accidents. In the two-wheeled group, only 15 % did not have facial or skull base fractures. Fractures often occur in multitudes as 39 % of all patients have multiple facial or skull bone fractures, and thus, emergency radiologists should be familiar with the complexity of the injuries. Negative clear sinus sign and low-energy sentinel injuries should be trusted as indications of undetected injuries in MVA victims.

High-Energy Traumatic Maxillofacial Injury

“…The 2 most common subgroups of facial injuries that can be classified as HET injuries are GSWs and high-velocity MVCs, and the most common facial fractures resulting from a high-energy GSW and MVCs are the nasal, orbital, maxillary, zygomatic, and mandibular bones. 8,17,22,23 Prior larger studies have reported both the mandible 6,10 and the zygoma 24 as the most commonly injured maxillofacial bones in GSWs to the face. Based on the geometry of the face, protruding areas are most likely to sustain injury in highenergy MVC.…”

“…5,16,17 Orbital and nasal fractures commonly occur together in these types of injuries and may accompany high-energy Le-Fort fractures. 8,18 The bone associated with the frontal sinus structure can withstand between 800 and 2200 lb of pressure, and the presence of fractures at this site likely indicates high-energy trauma. 8,18-20 Furthermore, a previous study analyzing force of impact established a resistance to fracture of the frontal bone at 1350 lb of force, compared with the more fragile mandibular and zygomatic bones at 427 and 360 lb of force, respectively.…”

“…The extent of damage from the MVC is caused primarily by the velocity of the vehicle, direction of impact, force of secondary collision between the occupant and the vehicle, impact interface geometry of opposing surfaces, and the use of seatbelts. 8,9,30 The force equation, force ¼ mass  acceleration, can be used to determine the energy transferred to the facial skeleton upon impact. During a 30-mph collision, a 15-lb head could experience up to 80 g of acceleration.…”

“…The extent of facial tissue damage caused by HET is directly related to the mechanism of injury and is highly variable. [7][8][9] In many patients, low-energy injuries can be treated with a more straightforward therapeutic approach because of limited displacement, fewer fractures, and predictable outcomes. 9,10 High-energy injuries are, however, associated with extensive hard and soft tissue disruption and loss of continuity 11 (Fig.…”

Significance of post-traumatic maxillary sinus fluid, or lack of fluid, in a level II trauma population

“…Mechanisms of injury were most commonly Bstruck by^injuries (e.g., falling objects and sports), falls, and motor vehicle accidents [3]. In motor vehicle accidents, nasal, orbital, and skull base fractures are most common [4], and in patients with falling accidents, zygomatic complex, nasal, and orbital fractures are most common [5]. Facial trauma patients are most commonly evaluated using CT due to its high sensitivity for detection of facial fractures and the ability to detect soft tissue injuries [6,7].…”