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Incidence of Major and Minor Brain Injuries in Facial Fractures

Grant, Aaron L. MD*; Ranger, Adrianna MD, FRCSC; Young, G. Bryan MD, FRCPC; Yazdani, Arjang MD, FRCSC*

doi: 10.1097/SCS.0b013e31825e60ae
Original Articles

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.

From the University of Western Ontario *Division of Plastic Surgery, †Department of Neurosurgery, and ‡Department of Neurology, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada.

Received April 5, 2012.

Accepted for publication May 6, 2012.

Address correspondence and reprint requests to Aaron L. Grant, MD, University of Western Ontario Division of Plastic Surgery, London Health Sciences Centre, Victoria Hospital, Room E2-214 800 Commissioners Rd East, London, Ontario, Canada N6A 4G5; E-mail:

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD