Etiologyincidence

The etiology of facial fractures varies between urban and rural environments. Penetrating trauma and assault-related injuries are more common in cities, whereas motor vehicle crashes (MVCs), sporting, and other recreational injuries are seen frequently in community hospitals. In community emergency departments (EDs), the nose and mandible are the most common facial fractures; in trauma centers, however, midface and zygomatic injuries are more frequent. Domestic violence and elder and child abuse are important causes of facial trauma. Facial injury accounts for the majority of ED visits related to domestic violence. As many as one-fourth of women with facial trauma are victims of domestic violence.1 If a woman has an orbital fracture, the likelihood of sexual assault or domestic violence rises to more than 30 percent.2 Falls are also an important cause of facial injury in the very young and the elderly.

Potential injuries associated with facial trauma are those of the head, cervical spine, and eye. As many as 20 to 50 percent of victims of facial trauma sustain concurrent brain injury, especially those with upper face and midface fractures.

Although most series show no increased incidence in cervical spine injury with facial trauma (1 to 4 percent), this is of statistical interest only. One must consider possible spinal injury in all patients with significant or suspected maxillofacial fractures, because it takes considerable force to shatter the midface or upper face. Always rule out cervical spine injury clinically or radiographically in such patients. One study has linked carotid artery injury to severe facial trauma. 3

Periorbital fractures may be associated with globe disruption. The dangerous triad of limited extraocular movement, limited visual acuity, and limited visual fields should be checked in all those with facial injury.

Blindness occurs in 0.5 to 3 percent of patients with facial fractures and is most frequent in patients with LeFort III (2.2 percent), LeFort II (0.64 percent), and zygomatic fractures (0.45 percent).4 MVCs and gunshot injuries are responsible for most cases of visual loss.

In addition to the physical consequences of facial trauma, there are psychological costs as well. More than one-quarter of patients with significant facial trauma may develop posttraumatic stress disorder.5

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