P01 - Epidemiologic Review of Panfacial Fractures at a Single Institution

Abstract: Within maxillofacial trauma literature, there is frequent discussion related to treatment of panfacial fractures. However, there is a paucity of literature reviewing the epidemiologic factors in this patient population. This study aims to identify epidemiologic trends among patients who sustained panfacial fractures within our institution. Records were reviewed for patients that were seen and evaluated at The University of Tennessee Medical Center in Knoxville (UTMCK) between January 2011 and February 2022.

An IRB-approved (#4920) retrospective cohort study of 12,534 patients with maxillofacial trauma requiring oral and maxillofacial consultation between 2011 and 2022 at a single Level I Trauma Center (UTMCK) were included in the study. 60 patients met inclusion criteria.

Inclusion criteria: Patients with maxillofacial fractures in all facial thirds defined as:

Upper third: frontal bone including frontal sinus or superior orbital rim

Middle third: facial bones inferior to frontal bone and superior to the mandible

Lower third: mandibular fracture



Exclusion criteria: Patients with maxillofacial fractures in 2 or less facial thirds. Patients that expired prior to OMFS consultation.

Descriptive statistics were computed for all variables. Independent sample t test and ANOVA were used to determine significant differences in the FISS for binary and categorical variables respectively. Variables with a P-value < 0.05 were deemed statistically significant. The final study sample consisted of 60 patients with panfacial fractures. The mean patient age was 40.7 years (SD, 17.0 years). Most patients were White (91.7%) males (88.3%). The most common season of injury was summer (33.3%). The mean length of stay was 16.7 days (SD, 12.4 days).

The most common mechanism of injury was motor vehicle collisions (MVC) (48.3%). The majority of patients were treated in the operating room (76.7%). Half of the patients were discharged home and mortality occurred during the hospital stay of seven patients (11.7%). Ultimately, no variable was a significant predictor for the FISS score.

The term “panfacial fracture” is often misused in communication between providers and the consulted oral and maxillofacial surgeon. Within the literature, the definition is fluid and has evolved over time with some preferring to create facial quarters instead of the traditional facial thirds. Previous studies have detailed high energy mechanisms such as MVC, assaults (37.4%), work accidents (20.7%), and bicycling accidents (19.4%) as common mechanisms of injury in panfacial fracture patients1. A review of the literature found a male predilection with 87.2% of panfacial fracture patients, with an average age of 36.2 years (SD, 14.3 years) ranging from 4 to 75 years1.

The present study had similar findings with an average age of 40.7 years, (range 10-79 years) and 88.3% male. The most common etiologies were MVC (48.3%), self-inflicted gunshot wound (15%), and falls (13.3%). The most common fractures were frontal bone (100%) and mandible (100%) as those were required for inclusion criteria. Within the midface, the most common fractures were zygomaticomaxillary complex (ZMC) (58.3%), orbital floor without ZMC component (36.67%), and other maxillary fractures (36.67%).

UTMCK serves 40 counties in East Tennessee and surrounding states. The patient population evaluated reflects the demographics of southern Appalachia where greater than 90% of residents identify as White. The limitations of this study include its retrospective nature and conduction at a single institution.



References

1. Lin, C., Wu, J., Yang, C., Zhang, C., Xu, B., Zhang, Y., & Zhang, S. (2021). Classifying and standardizing panfacial trauma according to anatomic categories and Facial Injury Severity Scale: A 10-year retrospective study. BMC Oral Health, 21(1). https://doi.org/10.1186/s12903-021-01900-w