Characterization of midface fractures incurred in recent wars.

BACKGROUND: Facial injuries sustained by US military personnel during the wars in Iraq and Afghanistan have increased compared with past conflicts. Characterization of midface fractures (orbits, maxilla, zygoma, and nasal bones) sustained on the battlefield is needed to improve our understanding of these injuries, to optimize treatment, and to potentially direct strategic development of protective equipment in the future. METHODS: The military's Joint Theater Trauma Registry was queried for midface fractures from 2001 to 2011 using International Classification of Diseases, Ninth Revision diagnosis codes. Stratification was then performed, and individual treatment records from Brooke Army Medical Center were reviewed. Analysis of the fracture pattern, treatment, and complications was performed. RESULTS: One thousand seven hundred sixty individuals with midface fractures were identified. Those fractures sustained in battle were characterized by a predominance of open fractures, blast etiology, and associated injuries. Detailed record reviews of the patients treated at our institution revealed 45% of all midface fractures as operative. Thirty-one percent of these were treated at levels III and IV facilities outside the continental United States before arrival at our institution. Patients with midface fractures underwent multiple operations. There was a 30% rate of complication among operative fractures characterized by malalignment, implant exposure, and infection. Midface battle injuries also had a high incidence of orbital fractures and severe globe injuries. CONCLUSIONS: Midface fractures sustained in the battlefield have a high complication rate, likely as a result of the blast mechanism of injury with associated open fractures, multiple fractures, and associated injuries. These cases present unique challenges, often requiring both soft tissue and skeletal reconstruction.

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

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.