Traumatic brain injuries and maxillofacial fractures: a systematic review and meta-analysis.

Traumatic brain injuries (TBIs) associated with maxillofacial fractures (MFFs) are a public health concern worldwide, especially among adult-aged males. There is an urgent need for early detection of associated TBIs in patients with MFFs during the initial assessment and treatment stage to reduce morbidity and mortality. The objective of the present study was to systematically review the literature to determine specific MFF situations associated with TBIs and to identify the factors associated with TBIs in patients with MFFs. The protocol was developed in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020155912. Overall, of 26,774 patients recorded, 13,667 patients (51.04%) sustained MFFs with an associated TBI. The male to female ratio was 4.8:1. RTA was the most common cause. The most common TBIs were concussions, contusions, and closed brain injuries. Within the limits of this study, it was concluded that TBI-related MFFs should be suspected whenever maxillary or mandibular bone fractures occur, especially among adults, males, and people with injuries caused by RTAs and assaults. There is a need to increase the awareness of maxillofacial surgeons on the possible associations of combined maxillofacial trauma and brain injuries.

A Retrospective Study Examining the Presentation and Management of Maxillofacial Soft Tissue Injuries Over 3 Years at a Regional Children's Hospital and the Introduction of a Maxillofacial Laceration Grading Scale.

Pediatric trauma has been affected by COVID-19, school closures, and stay at home advice. Health seeking behavior has decreased. The aim of this study is to assess trends in the presentation of maxillofacial soft tissue injuries and subsequent management within a regional pediatric hospital. Retrospective study over a 3-year period (from 2019 to 2021 between the months of January and April). Inclusion of all pediatric patients seen by Oral and Maxillofacial Surgery team. Between 2019 and 2021, the total number of patients dropped by over half. The average age dropped from 5.9 in 2019 to 3.8 in 2021. Males were more commonly seen. Falls are the most common cause of injuries across 2019 to 2021. Extraoral injuries increased by 21%. Intraoral injuries reduced by 8%. Lip lacerations accounted for most injuries. In 2020, there was 21% reduction in conservative management of injuries. Wound closure under local anesthetic peaked in 2020, by 12%. Wound closure under general anesthetic has increased by 5%, and accounts for nearly a third of all injuries in 2020 and 2021. Patients are becoming younger and more likely to be male. Conservative management is most common but closure under local anesthetic and general anesthetic has increased. This may indicate an increase in the severity of soft tissue injuries or a trend toward operative management. We also introduce a laceration grading scale for clinician use to assist in assessing and documenting injury severity. Further research is needed to assess whether these trends continue or revert to prepandemic trends.

A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study.

PURPOSE: To assess physical examination findings related to maxillofacial trauma to identify patients at risk of midfacial and mandibular fractures and then to construct a clinical decision aid to rule out the presence of midfacial and mandibular fractures in emergency department patients. METHODS: We performed a prospective multicentre cohort study in four hospitals in the Netherlands, including consecutive patients with maxillofacial trauma. Each patient received a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular traumas, respectively. Consequently, clinical decision aids were constructed with the focus being on ruling out the presence of midfacial and mandibular fractures, and diagnostic accuracy was calculated. RESULTS: A total of 993 consecutive patients were identified of whom 766 and 280 patients were suspected of midfacial and mandibular fractures, respectively. Midfacial fractures were diagnosed in 339 patients (44.3%), whereas mandibular fractures were observed in 66 patients (23.6%). The decision aid for midfacial trauma consisting of peri-orbital hematoma, epistaxis, ocular movement limitation, infra-orbital nerve paresthesia, palpable step-off and tooth mobility or avulsion, produced a sensitivity of 89.7 (86.0-92.5), a specificity of 42.6 (38.0-47.4), and a negative predictive value of 83.9% (78.4-88.2). The decision aid for mandibular trauma consisting of the angular compression test, axial chin pressure test, objective malocclusion, tooth mobility or avulsion and the tongue blade bite test resulted in a sensitivity of 98.5 (91.9-99.7), a specificity of 34.6 (28.5-41.2), and a negative predictive value of 98.7% (92.8-99.8). CONCLUSION: The constructed clinical decision aids for maxillofacial trauma may aid in stratifying patients suspected for midfacial and mandibular fractures to reduce unnecessary diagnostic imaging. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov with the identifier NCT03314480.

Revisión sistemática de exactitud diagnóstica de la ultrasonografía en el trauma maxilofacial / A systematic review of ultrasound diagnostic accuracy in maxillofacial trauma

Esta revisión sistemática evaluó el rendimiento de la ultrasonografía (US) en el trauma maxilofacial. Dos investigadores independientes realizaron una búsqueda sistemática de artículos sobre US que evaluaron el diagnóstico de fracturas y/o traumatismos maxilofaciales. Se encontraron doce artículos entre los años 2010 y 2022. Cuatro artículos revisaron fracturas de los huesos nasales, cinco artículos fracturas del complejo cigomático, dos artículos fracturas orbitarias, tres artículos fracturas mandibulares y un artículo el hematoma retrobulbar, considerando que un artículo puede revisar más de un tipo de fractura. Todos los estudios fueron de cohortes retrospectivas o prospectivas. Los valores de sensibilidad y especificidad, informados en rangos de mayor y menor sensibilidad y especificidad en todos los estudios incluidos fueron, respectivamente, del 88-100 % y 88-100 % para las fracturas de los huesos nasales, del 88-100 % y 87-100 % para el arco cigomático, del 88-100 % y 100 % para el reborde infraorbitario, del 87 % y 100 % para el piso de la órbita, del 80-100 % y 100 % para la mandíbula y del 95,7 % y 99,7 % para el hematoma retrobulbar. Con cierto riesgo de sesgo en su aplicabilidad según la herramienta QUADAS-2, la US tiene un buen rendimiento en el diagnóstico de las fracturas faciales. Aunque la US no reemplaza a la TC, es útil en el punto de atención para optimizar las decisiones clínicas, siendo especialmente de ayuda en el trauma facial, el trauma nasal aislado y en grupos radiosensibles como niños y mujeres embarazadas. (AU)

This systematic review assessed the performance of ultrasonography (US) in maxillofacial trauma. A systematic search was performed by two independent researchers for articles on US for diagnosing maxillofacial fractures and/or trauma. Twelve articles were found between 2010 and 2022. Four articles reviewed nasal bone fractures, five articles zygomatic complex fractures, two articles orbital fractures, three articles mandibular fractures, and one article retrobulbar hematoma, considering that an article can review more than one type of fracture. All studies were retrospective or prospective cohorts. Sensitivity and specificity values, reported in ranges of highest and lowest sensitivity and specificity in all included studies, respectively, were 88-100 % and 88-100 % for nasal bone fractures, 88-100 % and 87-100 % for zygomatic arch, 88-100 % and 100 % for the infraorbital rim, 87 % and 100 % for the orbital floor, 80-100 % and 100 % for the mandible, and 95.7 % and 99.7 % for retrobulbar hematoma. With a certain risk of bias in its applicability according to the QUADAS-2 tool, US has a good performance in the diagnosis of facial fractures. Although US does not replace CT, it is useful at the point of care to optimize clinical decisions, being especially helpful in facial trauma, isolated nasal trauma, and in radiosensitive groups such as children and pregnant women. (AU)

Real-time screening tool for identifying post-traumatic stress disorder in facial trauma patients in a UK maxillofacial trauma clinic.

Post-traumatic stress disorder (PTSD) is a distressing consequence of a traumatic event associated with an increased suicide risk and reduced quality of life. Surgeons often have low confidence in identifying psychological problems. The prevalence of PTSD following facial trauma ranges from 23% to 41%. This highlights the importance of identifying and managing at-risk patients to optimize both mental and physical recovery. IMPARTS (Integrating Mental and Physical healthcare: Research, Training and Services) provides electronic screening tools to guide the non-mental health clinician in the 'real-time' identification, documentation, and management of potential mental health problems. The bespoke IMPARTS facial trauma screening tool was piloted in a UK oral and maxillofacial surgery trauma clinic from July 2015 to November 2017. A total of 199 patients completed screening, with 48 (24%) screening positive for possible PTSD. Further analysis of these 48 patients revealed that four (8%) had PTSD symptoms alone; three (6%) also screened positive for depression, 17 (35%) for co-existing symptoms of anxiety, and 24 (50%) for PTSD, anxiety, and depression. IMPARTS was found to be a highly effective tool aiding the non-mental health clinician to screen for PTSD and initiate prompt management. The data captured informs planning of the psychological support service.

Checklist for the initial evaluation of oral and maxillofacial trauma.

BACKGROUND/AIM: The standardization of the maxillofacial examination using a validated checklist is highly important. A checklist can also be a valuable tool for epidemiological studies, as it provides all clinical information related to maxillofacial trauma. The aim of this study was to propose a new checklist for the initial evaluation of maxillofacial trauma. MATERIAL AND METHODS: The development and validation of the new checklist were performed in four consecutive phases: (a) determination of items and development of the checklist; (b) analysis by experts; (c) pre-test; and (d) pilot study. The checklist was designed as follows: (a) Specific signs and symptoms (Part 1); (b) Specific signs and symptoms (Part 2); (c) Intraoral signs and symptoms; and (d) Imaging examination. RESULTS: A good level of agreement was found among the experts and no items were excluded during the validation step. The administration of the instrument to the target population revealed the lack of some important aspects of the clinical evaluation, such as halitosis, otorrhea, petechiae, eyelid ptosis, hypo/hyperacusis, and temporomandibular join sounds. These missing signs were included in the final version. CONCLUSIONS: This checklist is a practical guide that can be used by specialists or students in oral and maxillofacial surgery and it can contribute to the quality of health care at outpatient and oral-maxillofacial surgery services for patients with maxillofacial trauma.

Effect of Oral and Maxillofacial Injuries on the Development of Post-Traumatic Stress Disorder: A Cross-Sectional Study

ABSTRACT Objective: To assess the influence of oral and maxillofacial trauma on the development of Post-Traumatic Stress Disorder (PTSD) and to determine the efficiency of the Impact of Event Scale-Revised (IES-R) as a diagnostic tool for detecting PTSD in patients with Oral and Maxillofacial injuries. Material and Methods: PTSD was assessed one month postoperatively by the diagnostic instrument, IES-R, to arrive at a provisional diagnosis. A structured clinician-administered PTSD Scale then assessed the patients for the Diagnostic and Statistical Manual of Mental Disorders-5th edition (CAPS-5) to establish a final diagnosis. The assessment of the severity of PTSD was done based on various types of oral and maxillofacial injuries. Results: The IES-R scale provisionally diagnosed 54 subjects with PTSD, out of which 42 were diagnosed to have PTSD by the CAPS-5 scale. Subjects with injuries involving the 'orbital complex,' those presenting with a perceptible scar in the maxillofacial region and with multiple avulsed/ luxated anterior teeth, showed a higher affinity to develop PTSD, and this was statistically significant. Conclusion: Higher levels of PTSD in patients with injuries to the maxillofacial region warrants correct diagnosis and detection, and hence the maxillofacial surgeon plays a vital role in this regard. The IES-R is a useful diagnostic tool to detect PTSD early.

Maxillofacial injuries in pregnancy following domestic abuse: A challenge in management.

Domestic violence against women remains one of the most difficult obstacles in the growth of civilization. The maxillofacial region is commonly involved, and injuries are complex to characterize and manage due to diverse presentations, underlying physiological changes and sometimes an association with pregnancy complications, creating a challenge for the operating surgeon. This case report discusses the clinical presentation of maxillofacial injuries sustained by a pregnant woman who also had obstetric complications. The management of such trauma by a multidisciplinary squad led by the maxillofacial surgery team is outlined. Increasing awareness among oral healthcare providers for the early identification of interpersonal abuse along with timely intervention and adequate referral is important. Close monitoring and follow-up are also mandatory.

Caracterización del trauma maxilofacial grave en dos servicios de urgencia de La Habana, Cuba / Characterization of severe maxillofacial trauma in two emergency departments in Havana, Cuba

RESUMEN Introducción: Las lesiones faciales pueden afectar la capacidad del paciente para comer, hablar e interactuar. Objetivo: Caracterizar el trauma maxilofacial grave en el servicio de urgencia del Hospital Universitario "General Calixto García" y "Miguel Enríquez", La Habana, Cuba. Métodos: Se realizó un estudio descriptivo transversal multicéntrico en los servicios de urgencia del Hospital Universitario "General Calixto García" y Hospital "Miguel Enríquez" de marzo 2017 a marzo 2019. Se estudió el universo de pacientes con diagnóstico de trauma maxilofacial grave. Las variables cualitativas fueron sexo, etiología, ingestión de bebidas alcohólicas y lesiones, y la cuantitativa fue edad. Se confeccionó una planilla de recolección de datos y la información se introdujo en una base de datos. Se emplearon números enteros, porcentajes y tablas estadísticas. Se buscó la asociación entre variables. Resultados: El sexo masculino constituyó un 80,6 por ciento. El grupo de edad más representado fue el de 18-30 años (33,3 por ciento), seguido por el de 31-40 (25,0 por ciento). En el 41,7 por ciento de los pacientes el trauma estuvo relacionado con accidentes del tránsito, y en el 30,6 por ciento con violencia interpersonal. En el 51,9 por ciento de los pacientes se detectó aliento etílico, con mayoría de los atendidos en el Hospital "Miguel Enríquez". Predominaron las heridas mayores de 2 cm, seguidas por las de menos de esa longitud (61,1 por ciento y 32,4 por ciento, respectivamente) y la fractura mandibular (51,9 por ciento). Conclusiones: Hubo predominio del sexo masculino y grupo de edades de 18-30; como principal etiología estuvieron los accidentes de tránsito, seguidos de la violencia interpersonal; las lesiones de tejidos blandos más frecuentes fueron las heridas mayores de 2 cm y las de tejidos duros, las fracturas mandibulares. Hubo una asociación significativa de la ingestión de bebidas alcohólicas en los pacientes tratados en el Hospital "Miguel Enríquez"(AU)

ABSTRACT Introduction: Facial injuries may affect patients' capacity to eat, speak and interact. Objective: Characterize severe maxillofacial trauma in the emergency departments of General Calixto García University Hospital and Miguel Enríquez Hospital in Havana, Cuba. Methods: A descriptive cross-sectional multicenter study was conducted in the emergency departments of General Calixto García University Hospital and Miguel Enríquez Hospital from March 2017 to March 2019. The study universe was patients diagnosed with severe maxillofacial trauma. The qualitative variables were sex, etiology, consumption of alcoholic beverages and injuries, whereas the quantitative variable was age. A data collection form was developed and the information was stored in a database. Data were expressed in whole numbers, percentages and statistical tables. A search was performed for the relationship between the variables. Results: Male sex constituted 80.6 percent of the sample. The best represented age group was 18-30 years (33.3 percent), followed by 31-40 (25.0 percent). In 41.7 percent of the patients the trauma was related to traffic accidents, and in 30.6 percent to interpersonal violence. Alcohol breath was detected in 51.9 percent of the patients, among them most of those cared for at Miguel Enríquez Hospital. There was a predominance of wounds larger than 2 cm, followed by wounds under that length (61.1 percent and 32.4 percent, respectively) and mandibular fracture (51.9 percent). Conclusions: A predominance was found of the male sex and the 18-30 years age group; the main etiology was traffic accidents, followed by interpersonal violence; the most common soft tissue injuries were wounds larger than 2 cm, whereas the most common hard tissue injuries were mandibular fractures. A significant association was found with consumption of alcoholic beverages among the patients treated at Miguel Enríquez Hospital(AU)

Pediatric Maxillofacial Trauma Patterns Among Different Types of Road Traffic Accidents.

BACKGROUND: Traffic accidents are one of the most leading cause of maxillofacial trauma. Defining the bone fracture patterns in different type of traffic accidents may enable for appropriate surgical approach. OBJECTIVES: This study research the pattern of pediatric maxillofacial fractures in terms of different type of traffic road accidents and age groups. METHODS: The data on road traffic accidents that caused maxillofacial trauma between May 2014 and January 2019 was gained from the University of Gaziantep hospital data system. Road accident type, age groups, and the type of fractures were the evaluation parameters. RESULTS: A total of 61 patients meet the criteria and 41 of those were boys. The midface bones of orbital, maxillar, and frontal are the most fractured structures with a total number of 48. The least fractured bone was mandibula with a number of 4. The comparisons of these fractures among the different type of road traffic accidents and age groups were found to be statistically significant. CONCLUSION: Car-pedestrian and car-passengers type of road traffic accident mostly seem to cause midface fractures at the primary and secondary school-aged children.

The Correlation of Age and Patterns of Maxillofacial Bone Fractures and Severity of Associated Injuries Caused by Motorcycle Accidents.

BACKGROUND: Every year, there are significant numbers of motorcycle accident casualties in Taiwan. These accidents are the leading cause of maxillofacial trauma. Age should be an important factor of maxillofacial fracture patterns yet there is limited literature on the topic. Therefore, this study aims to evaluate the correlation of age with maxillofacial fracture in motorcycle accidents. METHODS: This is a retrospective descriptive analysis conducted over 2-year period at Linkou Chang Gung Memorial Hospital. We focused on the population of maxillofacial injury caused by motorcycle accidents. Data, including demographics, age, fracture patterns of facial bones, and other associated injuries, were collected. RESULTS: Among 881 admissions, there were 179 patients in the minor group, 644 patients in the adult group, and 58 patients in the geriatric group. With patterns of maxillofacial fracture, midface fracture was the most common type. The minor group had higher incidence of mandibular fracture. The geriatric group sustained more midface fracture. Associated injuries, such as severe head injuries and c-spine injury, were more likely to occur with the old age victims. The overall mortality rate was 3.1%. CONCLUSIONS: Our study presents the different trends of fracture patterns in different age groups, which is associated with different types of treatment required. We summarized all these data in the hope of providing further assistance to trauma doctor dealing with motorcycle accidents.

Feasibility of a craniometry in a comminuted zygomaticomaxillary complex fracture.

Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex (ZMC) fracture management. We present our experiences with this procedure and a review of the related literature.From September 2011 to October 2018, 43 patients with comminuted ZMC fracture receiving open reduction internal fixation under coronal incision were enrolled. Data on gender, age, operation time, hospital stay, duration of follow-up, vertical/horizontal differences, and complications were collected. Between-group differences (C-arm imaging vs craniometry) were evaluated using nonparametric Mann-Whitney test for continuous data and chi-square test for categorical data.No significant difference were found between the groups regarding gender, age, hospital duration, follow-up duration, and postoperative complications, except for operation time. The averaged operation time was significantly shorter in the C-arm imaging group (4.217 h) than in the craniometry group (6.193 h). The C-arm imaging group had two cases with horizontal differences >3 mm and one case with vertical differences >3 mm. The craniometry group had four cases with horizontal differences >3 mm and four cases with vertical differences >3 mm. There were no significant differences between the two groups in horizontal differences and vertical differences.Craniometry may achieve the same outcomes as C-arm imaging in comminuted ZMC fracture management; however, the former requires more time than the latter.

Microsurgical reconstruction of complex maxillofacial gunshot wounds: Outcomes analysis and algorithm.

BACKGROUND: Satisfaction with appearance, functional outcomes (speech, swallowing), work status after microsurgical reconstruction for maxillofacial gunshot wounds (GSW) remain largely unknown. The purpose of this study is to report these parameters. By investigating these outcomes, we also aimed to provide microsurgical algorithms for complex maxillofacial GSW. METHODS: Forty-two consecutive maxillofacial GSW patients between 2006 and 2014 were analyzed for outcomes. Mean age was 41.3 years ranging 14 to 77 years. There were 33 males and 9 females. RESULTS: Twenty-four patients received 36 free flaps for early reconstruction in 1 to 2 weeks, two patients in a delayed manner. Fifteen fibula flaps for mandible reconstruction, five fibula, there radial forearm (RF), and two scapular osteocutaneous (OC) flaps for maxilla reconstruction, two RF flaps for palate reconstruction, one RF for cheek reconstruction were used. Four patients underwent innervated gracilis flap for total lower lip and one for cheek reconstruction. Rectus abdominis myocutaneous flap was used for mid-face defects in two patients. One anterolateral thigh flap was used for lower lip/chin reconstruction. Nine free flaps were performed to treat a complication and/or to improve function. All flaps survived except for three partial skin paddle loss to fibula flaps. Mean follow-up was 17.2 months. Return to work/school was 70%. Surveys noted 58% "satisfied". All patients but two achieved perceptible speech, the majority had no difficulty with swallowing, all patients had oral competence. CONCLUSIONS: Favorable outcomes were obtained in most maxillofacial GSW. After investigating these outcomes, microsurgical algorithms were developed for clinical practice for reconstruction of composite mandible and total-lower lip defects, and maxilla/mid-face defects.

Dentofacial traumatic injuries: A survey of knowledge and attitudes among emergency medicine physicians in Turkey.

BACKGROUND/AIM: Emergency department (ED) visits for dental issues are mostly related to traumatic injuries. The knowledge of ED physicians about the diagnosis and treatment of dentofacial injuries is crucial for prognosis. The aim of this study was to evaluate the attitude and knowledge as well as education and self-confidence levels of emergency medicine physicians in ED regarding the diagnosis and treatment of dentofacial traumatic injuries. MATERIAL AND METHODS: A total of 109 emergency medicine physicians participated in the study. Participants were residents and specialists who attended a national emergency medicine symposium held in Turkey. A questionnaire was distributed during the symposium relating to general data about physicians, their attitudes, basic knowledge, and confidence levels which were believed to be indicative of their capabilities in managing of traumatic dental and maxillofacial injuries. RESULTS: The questionnaire was answered by 109 physicians who were general practitioners (11%), emergency medicine residents (56.8%), and emergency medicine specialists (32.2%). The most experienced group of physicians were emergency medicine specialists. Regardless of the physicians' titles, dentofacial trauma knowledge levels of ED physicians were found to be insufficient. Having a dentist in the family (P < 0.01), the duration of emergency service experience (P = 0.04), and the age of the physicians (P < 0.001) were significantly related to the knowledge level. CONCLUSIONS: The majority of ED physicians had low knowledge regarding the diagnosis and treatment of dentofacial traumatic injuries. There is a need for education during and after medical training for ED physicians to provide appropriate primary management of dentofacial trauma.

The Diagnosis and Management of Facial Bone Fractures.

Appropriate medical care for a patient with a facial fracture can not only optimize aesthetic outcomes but also prevent the potential morbidity and mortality of delayed treatment. In this article, we focus on the clinical presentations, physical examination findings, diagnostic imaging, consultations, and follow-up that patients with facial fractures need related to their emergency department management. Specifically, we address the nuances of evaluating frontal, orbital, nasal, maxillofacial, and mandibular fractures.

Management and Outcome of Maxillofacial Trauma in a 9-Week-Old Dog.

This case report describes diagnosis, treatment, and outcome of maxillofacial trauma in a 9-week-old shih tzu. In addition to an open left mandibular body fracture and a right condylar process fracture, there were several relatively stable and minimally displaced right maxillary fractures. The torn soft tissues associated with the left mandibular body fracture were sutured closed, and a tape muzzle was placed. Due to sufficient fracture healing at the 2-week recheck examination, the tape muzzle was removed. The 6-week reexamination confirmed continued healing and recovery. Anesthesia was performed at the 5.5-month reexamination when the dog was 8 months old, revealing the presence of persistent deciduous teeth, linguoverted, malformed, and partially erupted permanent teeth, and asymmetric skeletal malocclusion (in addition to the breed-specific mandibular mesioclusion). Persistent deciduous teeth and linguoverted and malformed permanent teeth were extracted to allow for normal opening and closing of the mouth without traumatic occlusion. Long-term follow-up is recommended in juvenile dogs with maxillofacial injuries in order to prevent, recognize, and treat dental complications resulting from the trauma.

Ophthalmic Injuries Related to Maxillofacial Trauma Due to Urban Warfare.

: Midfacial trauma commonly causes ocular injuries of varying degrees. Eye injuries account for approximately 10% of all battle injuries. Severity of injuries may range from a subconjunctival haemorrhage to optic nerve injury and globe laceration and rupture. AIM OF STUDY: Is to evaluate the associated ophthalmic injuries in maxillofacial trauma due to war and to emphasize the need for proper ophthalmic examination to exclude and manage any associated ophthalmic injuries. MATERIALS AND METHODS: A total of 66 patients with maxillofacial trauma due to war were considered in this study and underwent classification of the fractures to know patterns of fractures and to specify the ophthalmic injuries which might be associated with each fracture. Referral to ophthalmologist was considered to determine the exact nature of ophthalmic injuries. Results by a maxillofacial surgeon and ophthalmologist were evaluated. RESULTS: Midfacial trauma particularly those associated with zygomatic bone fracture was highly significant due to blast and bullets can lead to serious ophthalmic injuries. This was related to 57% of ophthalmic injuries. The related ocular injuries which were subconjunctival hemorrhage and the rupture or lacerated eye globe found to be highly significant war injuries while the preretinal hemorrhage and diplopia were significant. CONCLUSION: A thorough proper ophthalmic examination should be carried out for every patient with these fractures and suspected cases should be placed under close observation so that immediate and active treatment can be taken if necessary.