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A single center review of radiologically diagnosed maxillofacial fractures: etiology and distribution
Ian C. Hoppe, MD, Jordan N. Halsey, MD, Anthony M. Kordahi, BA, Edward S. Lee, MD, Mark S. Granick, MD.
New Jersey Medical School - Rutgers University, Newark, NJ, USA.

BACKGROUND: The etiology of fractures of the maxillofacial skeleton varies amongst studies, with motor vehicle accidents and assaults oftentimes the most common. The number of males outnumbers females throughout most studies. Fractures of, the zygoma, orbit, and mandible are usually cited as most common. The distribution of fractures is likely dependent on the force imparted on the skeleton, with larger forces required to fracture stronger buttresses. This study examines a single center's experience with regards to etiology and distribution of fractures.
METHODS: A retrospective review of all radiologically diagnosed facial fractures in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patient demographics, etiology of injury, and location of fractures were collected.
RESULTS: During this time period 2,998 patients were identified as having sustained a fracture of the facial skeleton. The average age was 36.9 years, with a strong male predominance (81.5%). The most common etiologies of injury were assault (44.9%) and motor vehicle accidents (14.9%). Throughout the study period the number of fractures as a result of assault remained relatively constant, while the number as a result of motor vehicle accidents decreased slightly. The most common fracture observed was the orbit (46%), followed by mandible (39%), nasal (31%), zygoma (23.6%) and frontal sinus (9.9%). Patients sustaining a fracture as a result of assault were more likely to have a mandible fracture (p < 0.01). Patients in motor vehicle accidents were more likely to suffer fractures of the maxilla (p < 0.01), orbit (p < 0.05), and frontal sinus (p < 0.01).
CONCLUSIONS: Mandible fractures are likely more common in patients who were assaulted due to its prominent location and likelihood of being targeted by an assailant's fist. Motor vehicle accidents convey a large force, which when directed at the craniofacial skeleton causes fractures of the more resilient buttresses (maxilla and frontal bone). The decreasing number of fractures as a result of motor vehicle accidents may represent improved safety devices, such as airbags.

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