Maxillofacial fractures masking traumatic intracranial hemorrhages

Maxillofacial trauma may mask intracranial injuries prompting intensive care treatment. The purpose of this study was to identify whether craniofacial fracture patterns predispose patients with maxillofacial fractures to different types of intracranial hemorrhages. Within 7 years, 6649 patients with craniomaxillofacial injuries were admitted for treatment. The charts of the patients were analyzed according to age, sex, cause and mechanism of injury, type and location of facial injury, and intracranial trauma; 2195 sustained maxillofacial fractures. Statistical analyses were followed by logistic regression analyses for the four main types of intracranial hemorrhage to determine the impact of the different maxillofacial fractures. Intracranial hemorrhages in 212 patients (9.7%) occurred as epidural (2.5%), subdural (4.3%), subarachnoid (5.3%), and intracerebral hemorrhages (6.3%). Le Fort, orbit, nose, zygoma, and maxillary fractures increased the risk for accompanying intracranial hemorrhage by two- to fourfold (P < 0.05). Basal skull fractures caused a multiplication of the risk up to 17-fold, while fractures of the cranial vault were associated with a risk up to 14-fold. Nearly 10% of patients with craniomaxillofacial fractures sustain intracranial hemorrhages requiring frequently immediate neurosurgical intervention. Those patients, suffering from central midface fractures and skull base fractures, are prone to highly significant elevated risks of intracranial hemorrhage.