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Association of craniomaxillofacial fractures and blunt cerebrovascular injuries

  • E.M. Färkkilä
    Affiliations
    Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA

    Department of Oral and Maxillofacial Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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  • L.B. Kaban
    Affiliations
    Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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  • F.B.D.J. Boos-Lima
    Affiliations
    Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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  • Z.S. Peacock
    Correspondence
    Correspondence to: Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
    Affiliations
    Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

    Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Published:December 21, 2022DOI:https://doi.org/10.1016/j.ijom.2022.12.003

      Abstract

      High energy trauma has been considered a risk factor for blunt cerebrovascular injuries (BCVI). The purpose of this study was to determine the incidence and risk factors for BCVI specifically in patients with maxillofacial fractures in an urban level I trauma center. A retrospective cohort study of patients aged ≥ 18 years, admitted to Massachusetts General Hospital (MGH) between 2007 and 2017, was implemented. There were 23,394 patients treated and entered into the MGH Trauma Registry: 22,287 sustained blunt trauma. Of the total blunt trauma patients, 68 (0.3%) had BCVI. There were 2421 patients with CMF fractures from blunt trauma (mean ± standard deviation age, 53 ± 22 years; 29.9% female included as study subjects, of whom 24 (1.0%) had BCVI). In a multivariate model, all mandible fracture (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.6–11.6, P = 0.004), crush injury, defined as blunt compression injury (OR 11.1, 95% CI 2.1–58.1, P = 0.004), and cervical spine injury (OR 10.1, 95 CI 3.7–27.5, P < 0.001) were independent risk factors for BCVI. Mortality was 4.3 times higher in craniomaxillofacial fracture patients with BCVI versus those without BCVI; complications of BCVI (stroke) contributed to the majority of deaths. Appropriate screening and treatment of BCVI in patients with maxillofacial fractures is important.

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