Department of Oral and Maxillofacial Surgery, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland.
Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, PL 41, 00014 Helsingin Yliopisto, Helsinki, Finland; Helsinki University Hospital, Haartmaninkatu 4, PL 320, 00029, HUS, Helsinki, Finland.
Br J Oral Maxillofac Surg. 2024 Oct;62(8):704-709. doi: 10.1016/j.bjoms.2024.04.011. Epub 2024 Apr 30.
Concomitant traumatic brain injury (TBI) is common in facial fracture patients and prompt intervention is crucially important to minimise the risk of potential long-term sequalae. In order to achieve rapid diagnosis, clinicians need to be aware of the risk factors associated with concomitant TBI and facial fractures. Previous literature suggests that a facial fracture can be considered a significant indicator of TBI. Nevertheless, a large data gap remains on specific injury patterns of facial fractures and associated TBI. Therefore, the objective of this study was to estimate and compare the frequency of and risk factors for TBI in patients with and without different types of additional injuries. The retrospective cohort study included 1836 facial fracture patients aged at least 18 years. The outcome variable was TBI with radiological findings in computed tomography or magnetic resonance imaging. The primary predictor variables were associated injury outside the head and neck, associated cranial fracture and associated neck injury. Based on this study, associated cranial fracture increased the risk of TBI 4.7-fold. Patients with associated neck injury had a 2.1-fold risk of TBI. In addition, significant predictors for TBI were increasing age (p = 0.0004), high energy of injury (p < 0.0001) and anticoagulant medication (p = 0.0003). Facial fracture patients with associated injuries in the head and neck region are at significant risk of TBI. In clinical work, multiprofessional evaluation of facial fracture patients should be routine and repeated survey should be targeted especially at high-risk patients to identify TBIs.
合并创伤性脑损伤（TBI）在面部骨折患者中很常见，及时干预对于降低潜在长期后遗症的风险至关重要。为了快速诊断，临床医生需要了解与合并 TBI 和面部骨折相关的危险因素。既往文献表明，面部骨折可被视为 TBI 的一个重要指标。然而，对于面部骨折的具体损伤模式和相关 TBI 仍存在大量数据空白。因此，本研究旨在评估和比较合并不同类型附加损伤的患者中 TBI 的发生率和危险因素。这是一项回顾性队列研究，纳入了 1836 名年龄至少 18 岁的面部骨折患者。结局变量为 CT 或 MRI 显示有 TBI 的影像学结果。主要预测变量为头部和颈部以外的合并损伤、合并颅骨骨折和合并颈部损伤。基于本研究，合并颅骨骨折使 TBI 的风险增加了 4.7 倍。合并颈部损伤的患者 TBI 的风险增加了 2.1 倍。此外，TBI 的显著预测因素包括年龄增长（p=0.0004）、高能量损伤（p<0.0001）和抗凝药物治疗（p=0.0003）。有头部和颈部合并损伤的面部骨折患者有发生 TBI 的显著风险。在临床工作中，应对面部骨折患者进行多学科评估，应常规进行并针对高风险患者进行重复评估，以识别 TBI。
