The impact-absorbing effects of facial fractures in closed-head injuries

Abstract

A series of 210 patients with facial fractures sufficiently severe to require cranial computerized tomography (CT) to evaluate suspected closed-head injury (CHI) was studied. The injuries were separated into five grades of severity based on neurological examination, including cranial CT. The injuries were also grouped into three categories based on facial regional involvement, using chi-square contingency table analysis. The data demonstrated that patients with upper facial fractures were at greatest risk for serious CHI. Injuries to both the mandibular and the midfacial regions with no upper facial involvement more frequently resulted in mild CHI with a modest likelihood of no neurological deficits. Trauma to only the mandibular region or to only the midfacial region was least likely to involve CHI.

Epidemiologia do trauma facial

“…Embora se saiba que TCE leve não seja irrelevante, escolhemos focalizar os grupos de TCE moderado-grave para avaliar melhor o espectro da relação de trauma de face e acometimento simultâneo de encéfalo. Acometimento primário do encéfalo foi muito incomum em nosso trabalho, suportando o clássico trabalho de Sturla et al 17 da existência de "pilares" de sustentação craniofacial que determinam linhas de fratura anatomicamente relacionadas ao local e intensidade do impacto; nossos dados são ainda favorecidos pela teoria de que os ossos da face absorvem impacto pois são preenchidos por ar, servindo de coxim de proteção para o cérebro 18 . Porém, ainda não existe consenso, de modo que Martin et al 19 e Davidoff et al 16 consideram que as fraturas de face são marcadores para TCE grave e não protetores do encéfalo.…”

Biomechanics of Cranio-Maxillofacial Trauma

“…Whereas most of the authors like Bank, Lee et al [15,4] reported that facial fractures are associated with a decreased risk of brain injury, Davidoff et al [20] and very recently Keenan and others [21] found facial fracture to be highly associated with traumatic brain injury. They concluded that facial bones might not act as cushion to protect the brain against impact but infact are markers for increased risk of brain injury.…”

“…Lee et al [4] in the discussion of biomechanical aspects of facial trauma state that: In motor-vehicle collisions, the head is often subjected to forces many times that of gravity. As fractures occur, the facial skeleton absorbs some of the impact and cushions the brain against some of its violent effects.…”

“…Facial injuries are often accompanied with other associated injuries, like brain injuries [4,5]. The impact on the facial skeleton can be transmitted to the base of skull; the effect can range from transient loss of consciousness to more dangerous cereberal laceration [9].…”

“…The severity of it being expressed by the direction and the point of application of the force. In addition the pattern will be determined by the cross-sectional area of the agent or object struck [1][2][3][4].…”