Facial Fractures in Young Adults: A National Retrospective Study

Abstract

Objectives: “Young adulthood” is a term used to define individuals falling within the 18- to 22-year-old age range. Injuries account for more than a third of emergency department visits in this population. A particular area of concern is accidents that lead to injuries of the facial bones because they can have long-term functional, aesthetic, and psychosocial impacts. As many as 30 million young adults participate in some sort of sport in the United States per year, and facial injuries from these activities are not uncommon and thus require further exploration. Methods: The National Electronic Injury Surveillance System was used to conduct a retrospective review to explore patterns of maxillofacial fractures in young adult patients between the ages of 18 and 22 years from 2004 through 2017. The data analyzed yielded information about patient demographics, diagnoses, and associated products. Results: A total of 3486 emergency department visits were included in the study. The most common facial fractures were nasal fractures (64.4%), mandible fractures (12.3%), and orbital fractures (6.1%). The most common causes of fractures were sports (55.48%), fixed structures (6.39%), and stairs or steps (5.60%). The top 3 sports associated with facial fractures were basketball (25.4%), baseball (11.6%), and football (10.4%). Conclusions: For young adult individuals, some sort of sporting activity is common outside of the National Collegiate Athletic Association. The overwhelming majority of facial fractures in this population were caused by sports, and the authors believe this issue warrants further exploration and discussion. According to the Centers for Disease Control and Prevention, an estimated 8.6 million sports- and recreation-related injuries occurred per year between 2011 and 2014. Despite ever growing research and guidelines into sports injury incidence and prevention, it is clear that sports are the cause of a large portion of maxillofacial fractures in the United States.

Facial Fractures and the National Basketball Association: Epidemiology and Outcomes

“…36 Nasal bone fractures were the most common type of facial fracture sustained by NBA players in our study, which supports previous literature, both at professional and recreational levels. 7,9,10,26,36 Orbital fractures were also commonly sustained by NBA players in our study, which supports previous findings that orbital fractures are more common in basketball than other sports. 13 We found 57 cases of facial fracture over 33 seasons, translating to an incidence of 1.727 facial fractures per NBA season; yet, the actual rate is likely higher due to study limitations.…”

“…Serious complications including enophthalmos, diplopia, nasal obstruction, septal deviation, epiphora, olfactory disturbances, and temporomandibular joint dysfunction have been reported; even a simple nasal bone fracture has been associated with complication rates up to 10.4%. 10,11,15 Although this study is unable to assess long-term outcomes of player well-being, several studies show that facial injury has both quality of life 14 and long-term functional, aesthetic, and psychosocial ramifications. 11,38,39 It is worth noting that 11.3% of players in our study sustained a concomitant concussion at the time of fracture.…”

“…Studies have found long-term functional, aesthetic, psychosocial, and quality of life impacts of facial bone injuries. 10,14 Sportsrelated nasal fractures have been associated with complication rates of up to 15.2%. 15 Maxillofacial fractures have also been associated with traumatic head injuries, 16 an association that should not be overlooked given the growing concern surrounding concussions in sports.…”

“…The incidence of facial fractures in basketball is higher than in more aggressive, full contact sports (e.g., football), likely due to differences in protective gear protocols 8–9 . Basketball is a major cause of sports‐related facial fracture in children, young adults, and National Collegiate Athletic Association atheltes, 9–11 and the leading cause of sports‐related nasal fractures 12 . Orbital fractures are more common in basketball than other sports 13 …”

“…This paucity of literature may partly be due to the misconception that facial bone fractures are not as serious as orthopedic injuries to extremities. Studies have found long‐term functional, aesthetic, psychosocial, and quality of life impacts of facial bone injuries 10,14 . Sports‐related nasal fractures have been associated with complication rates of up to 15.2% 15 .…”