Physical Assault Is Increasingly the Most Significant Mechanism of Operative Facial Trauma in Adults

What trends can be determined from a study of operative middle and upper maxillofacial trauma incidents that occurred in one major U.S. city over a 17-year period?

BOTTOM LINE

Operative middle and upper maxillofacial trauma decreased over a 17-year period, with assault identified as the most significant mechanism of trauma overall.

BACKGROUND: More than 3 million facial traumas occur each year in the U.S. These injuries carry emotional, functional, and cosmetic repercussions for patients, and surgery to address them creates heavy financial burdens on hospital systems. A clearer understanding of facial trauma injury patterns and causes could improve prevention and treatment.

STUDY DESIGN: Retrospective case control study.

SETTING: Tina and Rick Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.

SYNOPSIS: Researchers collected data on surgically managed facial fractures that presented to the Los Angeles County + USC Medical Center, a level I trauma center, from July 1993 to July 2010, a total of 4,299 surgically managed facial trauma patients (88% male, mean age 34.6 years), representing 5,549 operative facial fractures. Of these fractures, 55% were repaired by otolaryngology, 21% by plastic surgery, 21% by oral and maxillofacial surgery, and 3% by ophthalmology. In adults, assaults were the most common injury mechanism (36%), followed by motor vehicle accidents (MVAs) (14%). In the pediatric population (< 18), MVAs were most common (27%), followed by assault (16%). Dividing the period into early (1993–2001) and late (2002–2010), researchers noted a 42% reduction in total operative maxillofacial trauma, with significant decreases in fractures from falls and “not otherwise specified” causes. However, the number of facial fractures due to assault significantly increased, with young males significantly more likely to be involved in trauma requiring operative repair. Researchers suggested future studies to assess whether interpersonal violence reduction initiatives could lower operative facial trauma. Study limitations included large numbers of unknown injury mechanisms and variations in charting over time.

CITATION: Su P, Paquet C, O’Dell K, et al. Trends in operative complex middle and upper maxillofacial trauma: A 17-year study. Laryngoscope. 2021;131:1985-1989.