Acute life-threatening injuries in facial fracture patients: A review of 1,025 patients

Background: The literature on facial fractures has emphasized obstruction o f the airway as the most common associated life-threatening problem, Other life-threatening injuries associated with facial fractures are not as well documented. For this reason, we conducted a retrospective study involving 1 ,025 patients with facial fractures admitted to the trauma center at Chang Gung Memorial Hospital in Taiwan from January 1995 through December 1998, Methods: This study identifies the incidence of facial fractures and establ ishes a management plan. Life-threatening injuries associated with facial f ractures were those that warranted immediate invasive rescue procedures. Results: Sixty-four (6.2%) of the patients with facial fractures required l ife-saving intervention; 21 patients had cerebral trauma prompting cranioto my, 19 had hemorrhagic shock, 17 had airway compromise, and 7 had pulmonary injury grave enough to necessitate tube thoracostomy, There were five mort alities, three due to cerebral trauma and two credited to hemorrhagic shock not identified until long after admission. Conclusion: These findings illustrate the need for prompt identification an d proper management of the associated life-threatening injuries in facial f racture patients. Clinical assessment should begin with evaluation of cereb ral trauma, followed by hemorrhagic shock, airway compromise, and hemopneum othorax, Proper management may require a multidisciplinary and coordinated team approach.