Purpose: The purpose of this study was to review patients who failed to sur
vive blunt trauma and to determine whether there is a relationship between
specific facial fracture patterns and death.
Patients and Methods: This was a retrospective record review of patients wi
th facial fractures admitted to a level I trauma center between January 1,
1993 and December 31, 1996. Records were reviewed for gender, age, injury s
everity score (TSS), Glasgow Coma Scale (GCS), revised probability of survi
val (RPS), cause of death, and facial fracture pattern. Facial fracture pat
terns were grouped as lower face (mandible), midface (maxilla, zygoma, nose
, and orbits), and upper face (frontal bone). Causes of death were grouped
into neurologic, visceral, combined neurologic and visceral, and other. Sur
viving and nonsurviving groups were compared. Parametric data were analyzed
with a pooled or separate variance t-test, nonparametric data with a Mann-
Whitney U-test, and categorical variables with a chi-square test (P less th
an or equal to.05). The odds ratio with corresponding 95% confidence interv
als was used to show the association between facial fracture patterns and d
eath.
Results: During the 4-year period, 6,117 patients were admitted with blunt
trauma, 661 (11%) of whom had facial fractures. Those who died were more li
kely to be older than those who survived, with a lower GCS, lower RPS, and
higher ISS. Although there was a male predominance in the patient populatio
n, there was no gender difference between those who died and those who surv
ived. Surviving patients were more likely to have only isolated mandible in
juries. Nonsurvivors were more likely to have isolated midface fractures or
combinations of midface and other facial fractures. The odds ratio showed
a 13 to 75 times greater risk of patients dying of neurologic injury with p
atterns other than isolated mandible injury than with any mid- or upper-fac
ial fracture patterns.
Conclusions: Compared with survivors, nonsurviving patients with facial fra
ctures were older and had a lower GCS, higher ISS, and lower RPS. Nonsurviv
ing patients had a dramatic predilection for mid- and upper-facial fracture
patterns and death of neurologic injury. (C) 2000 American Association of
Oral and Maxillofacial Surgeons.