Facial Fractures: Independent Prediction of Neurosurgical Intervention

CONTEXT: Over half of patients with facial fractures have associated traumatic brain injury (TBI). Based on force dynamic cadaveric studies, Lefort type 2 and 3 fractures are associated with severe injury. Correlation to neurosurgical intervention is not well characterized. AIMS: This study characterizes fracture pattern types in patients requiring neurosurgical intervention and assesses whether this is different from those not requiring intervention. SETTINGS AND DESIGN: Retrospective data were collected from the trauma registry from 2010 to 2019. SUBJECTS AND METHODS: Patients over 18, with confirmed facial fracture, reported TBI, available neuroimaging, and hospital admission were included. STATISTICAL ANALYSIS USED: Retrospective Contingency Analysis with Fraction of Total Comparison was used with Chi-square analysis for demographic and injury characteristic data. RESULTS: One thousand and one patients required no neurosurgical intervention and 171 required intervention. The intervention group had a significantly greater number of patients with Glasgow Coma Scale (GCS) <8 compared to the nonintervention group. Subset analysis revealed a twofold increase in Lefort type 2 fractures and notable increase in Lefort type 3 and panfacial fractures in the intervention group. Patients requiring craniectomy, craniotomy, or burr holes were much more likely to have Lefort type 2 or 3 fractures compared to those only requiring external ventricular drains or intracranial pressure monitoring. Subset analysis accounting for GCS supported these results. CONCLUSIONS: Lefort type 2 and type 3 fractures are significantly associated with requiring neurosurgical intervention. An improved algorithm for managing these patients has been proposed in the discussion. Ongoing work will focus on validating and refining the algorithm to improve patient care.