A ten-year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: incidence and aetiology

Abstract

In the literature it is questioned if the presence of maxillofacial trauma is associated with the presence of brain injury. The aim of this study is to present a 10-year retrospective study of the incidence and aetiology of maxillofacial trauma associated with brain injury that required both oral and maxillofacial and neurosurgical intervention during the same hospital stay. Forty-seven patients from a population of 579 trauma patients undergoing maxillofacial surgery were identified. The main cause of injury was road traffic collision, followed by falls. Interpersonal violence correlated less well with traumatic brain injury. Most of the patients were males, aged 20-39 years. Frontal sinus fractures were the most common maxillofacial fractures (21.9%) associated with neurosurgical input, followed by mandibular fractures and zygomatic complex fractures. In the general maxillofacial trauma population, frontal sinus fractures were only found in 2.2% of the cases. At presentation to the Emergency Department the majority of the patients were diagnosed with severe traumatic brain injury and a Marshall CT class 2. Intracranial pressure monitoring was the most common neurosurgical intervention, followed by reconstruction of a bone defect and haematoma evacuation. Although it is a small population, our data suggest that maxillofacial trauma does have an association with traumatic brain injury that requires neurosurgical intervention (8.1%). In comparison with the overall maxillofacial trauma population, our results demonstrate that frontal sinus fractures are more commonly diagnosed in association with brain injury, most likely owing to the location of the impact of the trauma. In these cases the frontal sinus seems not specifically to act as a barrier to protect the brain. This report provides useful data concerning the joint management of oral and maxillofacial surgeons and neurosurgeons for the treatment of cranio-maxillofacial trauma and brain injury patients in Amsterdam.

Keywords: Aetiology; Brain injury; Incidence; Maxillofacial trauma; Neurotrauma; Treatment.