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Ten years of war: A characterization of craniomaxillofacial injuries incurred during operations Enduring Freedom and Iraqi Freedom

Chan, Rodney K. MD; Siller-Jackson, Arlene PhD; Verrett, Adam J. DDS; Wu, Jesse MS; Hale, Robert G. DDS

Journal of Trauma and Acute Care Surgery: December 2012 - Volume 73 - Issue 6 - p S453–S458
doi: 10.1097/TA.0b013e3182754868
Original Articles

BACKGROUND Improved armor and battlefield medicine have led to better survival in the wars in Iraq and Afghanistan than any previous ones. Increased frequency and severity of craniomaxillofacial injuries have been proposed. A comprehensive characterization of the injury pattern sustained during this 10-year period to the craniomaxillofacial region is needed to improve our understanding of these unique injuries, to optimize the treatment for these patients, and to potentially direct strategic development of protective equipment in the future.

METHODS The Joint Theater Trauma Registry was queried from October 19, 2001, to March 27, 2011, covering operations Enduring Freedom and Iraqi Freedom for battle injuries to the craniomaxillofacial region, including patient demographics and mechanism of injury. Injuries were classified according to type (wounds, fractures, burns, vascular injuries, and nerve injuries) using DRG International Classification of Diseases—9th Rev. diagnosis codes.

RESULTS In this 10-year period, craniomaxillofacial battle injuries to the head and neck were found in 42.2% of patients evacuated out of theater. There is a high preponderance of multiple wounds and open fractures in this region. The primary mechanism of injury involved explosive devices, followed by ballistic trauma.

CONCLUSION Modern combat, characterized by blast injuries, results in higher than previously reported incidence of injury to the craniomaxillofacial region.

LEVEL OF EVIDENCE Epidemiologic study, level IV.

From the Dental and Trauma Research Detachment (R.K.C., A.S.-J., J.W., R.G.H.), US Army Institute of Surgical Research, Fort Sam Houston; Division of Oral and Maxillofacial Surgery (A.J.V.), Wilford Hall Military Medical Center, Lackland Air Force Base, Texas.

This study was conducted under a protocol reviewed and approved by the US Army Medical Research and Materiel Command Institutional Review Board and in accordance with the approved protocol.

The opinions or assertions contained herein are the private views of the authors are not to be construed as official or as reflecting the views of the Department of the Army, Air Force, or the Department of Defense.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journalãs Web site (

Address for reprints: Rodney K. Chan, MD, 3650 Chambers Pass, Fort Sam Houston, TX 78234; email:

© 2012 Lippincott Williams & Wilkins, Inc.