Purpose: Craniomaxillofacial fractures (CMFs) are common, but their association with concomitant intracranial hemorrhage (ICH) or blunt cerebrovascular injury (BCVI) is infrequent. The purpose of the present study was to investigate and compare CMF type in patients with ICH versus BCVI. Patients and Methods: The investigators designed and implemented a retrospective cohort study and enrolled all patients with CMF who had been managed at the University Hospital of Geneva between 2016 and 2021. The predictor variables were the types of CMF. The primary outcomes variables were ICH and BCVI. Secondary outcomes were death and survival with or without neurological sequelae. Other study variables included age, gender, etiology, Glasgow coma scale score, neurological symptoms and type of treatment. Descriptive, bivariate, and multiple logistic regression statistics were computed and significance level was set at P ≤ 0.05.
Results
The sample was composed of 1440 patients with a mean age of 46.6 years ± 24 years and 71% were men. Multivariate analysis showed that, with the exception of Le Fort I, nasal fractures and mandibular fractures, all the CMFs were strongly associated with ICH (P < 0.05). Pure orbital wall, Le Fort III, cranial vault fractures and basilar skull fractures were the only CMFs significantly associated with BCVI and ICH (P < 0.05). Le Fort I and nasal fractures were the only fractures not associated with either outcome. Secondary outcomes were negatively influenced by ICH and BCVI (P < 0.001). Conclusion
The results of this study demonstrated that the types of CMF associated with ICH differ from those associated with BCVI, thus indicating the possible role played by different fractures’ specific biomechanical damage mechanisms. Furthermore, the present findings suggest that Le Fort I and nasal fractures could be protective of cerebrovascular injuries, by cushioning impact forces.