Research Reports - Incidence of major and minor brain injuries in facial fractures

J Craniofac Surg. 2012 Sep;23(5):1324-8

Grant AL, Ranger A, Young GB, Yazdani A.

BACKGROUND: Facial fractures can be associated with brain and cervical spine
injuries because impact forces are transmitted through the head and neck.
Although major brain injury is commonly recognized in these patients, incidence
of minor brain injury is not well-known, despite potential morbidity and
mortality.
OBJECTIVES: This prospective study aimed to determine the incidence of both major
and minor brain injuries in 100 patients presenting to a craniofacial surgery
service with facial fractures and to identify characteristics associated with
brain injury.
METHODS: Data were collected for a 9-month period by a craniofacial surgeon at a
level I trauma center. A questionnaire and checklist were designed to capture
information about major and minor brain injury in patients with facial fractures.
Assessments were completed in the outpatient clinic, emergency department,
hospital ward, or intensive care unit during the first patient encounters.
RESULTS: The average age of patients was 34 years; 79% were male. Time between
injury and assessment ranged from less than a few hours to 4 months. Incidence of
brain injury was 67% overall: 29% with major brain injury and 38% with minor
injury. Major brain injury was commonly diagnosed early in the emergency
department or intensive care unit. Conversely, minor brain injury tended to be
diagnosed late in the clinic. Patient age, mechanism of injury, and type of
facial fracture predicted brain injuries overall, but mechanism of injury was the
sole predictor of minor brain injury.
CONCLUSIONS: Facial fractures are often associated with brain injury. A high
level of suspicion is warranted for minor traumatic brain injuries.

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