Remember the vessels! Craniofacial fracture predicts risk for blunt cerebrovascular injury

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Elina Varjonen, Frank Bensch, Tuomo Pyhältö, Mika Koivikko, Johanna Snäll
PurposeThe risk factors for blunt cerebrovascular injuries (BCVI) are currently under intensive research, yet it is still controversial who should be screened. This study aimed to determine if craniofacial fractures are associated with BCVI.MethodsThis retrospective cohort study focused on suspected polytrauma patients after whole body computed tomography including angiography of the cervical arteries. Patients were reviewed for BCVI and craniofacial fractures. Exclusion criteria were hanging injury, gunshot injury, or other penetrating injury to the neck, and a cervical fracture on any level. The outcome variable was BCVI, and the main predictor variable was a craniofacial fracture. A secondary predictor variable was a type of craniofacial fracture classified as a facial fracture, skull fracture, or a combination of a facial and skull fracture. Other predictor variables were gender, age, and mechanism of injury. In addition, specific craniofacial fractures were analyzed in more detail. The significance of associations between BCVI and the predictors underwent a chi-squared test. Significance was set at .01.Results428 patients aged 13 to 90 during a period of 12 months were included in the analysis. Craniofacial fractures occurred in 75 (17.5%). BCVI occurred significantly more frequently in those with than in those without a craniofacial fracture (18.6 vs. 7.4%, P = .002). Craniofacial fracture patients had a 4-fold increased risk for BCVI, whereas those in the age group 31–50 years had 3.4-fold increased risk. Type of craniofacial fracture, gender, and the mechanism of injury were not associated with BCVI.ConclusionCraniofacial fractures are a significant risk factor for BCVI. This research suggests that in patients with any craniofacial fracture and suspected polytrauma, rigorous imaging of cervical arteries in search of BCVI is essential.



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