The relationship between facial fractures and death from neurologic injury

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.