Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 3/2021

01-06-2021 | Facial Fracture | Original Article

Identifying risk factors of cerebrovascular injuries following blunt mandible fracture; a retrospective study from a national data base

Authors: Nasim Ahmed, Patricia Greenberg, Kayvon Haghighi

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2021

Login to get access

Abstract

Background

The purpose of this study was to determine the risk factors of cerebrovascular injury (CVI) in patients with blunt mandible fractures.

Methods

All patients who sustained a mandible fracture as a result of blunt force trauma from the 2012–2014 National Trauma Data Bank from the United State of America were included in the study. A CVI was noted as having occurred if there was an injury to the vertebral or carotid artery in the neck. Patients’ demography, injury mechanism, and additional fractures were compared between the groups of patients with and without CVI using univariate analyses. In addition, a multivariate logistic regression model was fit to identify risk factors for CVI in this cohort. All two-sided p values < 0.05 were considered statistically significant.

Results

Out of 29,398 patients who qualified for the study, only 398 (1.4%) patients sustained a CVI. There were significant differences (p < 0.001) identified between the groups regarding sex, race, mechanism of injury, occurrence of c-spine fracture, and of Le Fort II and III fractures in the univariate analysis. The risk factors identified by the multiple logistic regression model echoed these results and showed that female gender, injuries due to motorcycle, motor vehicle crashes and the presence of a cervical spine or Le Fort fracture were all associated with the occurrence of CVI (p < 0.05).

Conclusion

The patients with mandible fracture who were female and sustained a high impact blunt force mechanism had a significantly higher risk of CVI. These high-risk patients should be screened for CVI at the time of initial evaluation.
Literature
1.
go back to reference Lim KW, Kim JC, Kim SH, Kim SH. A clinical and statistical analysis of the facial bone fractures: from 1994 to 1998. J Korean Soc Plast Reconstr Surg. 1999;109:1151–9. Lim KW, Kim JC, Kim SH, Kim SH. A clinical and statistical analysis of the facial bone fractures: from 1994 to 1998. J Korean Soc Plast Reconstr Surg. 1999;109:1151–9.
2.
go back to reference Hwang K, You SH. Analysis of facial bone fractures: an 11-year study of 2094 patients. Indian J Plast Surg. 2010;43(1):42–8.CrossRef Hwang K, You SH. Analysis of facial bone fractures: an 11-year study of 2094 patients. Indian J Plast Surg. 2010;43(1):42–8.CrossRef
3.
go back to reference Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg. 1990;48(9):926–32.CrossRef Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg. 1990;48(9):926–32.CrossRef
4.
go back to reference Afrooz PN, Bykowski MR, James IB, Daniali LN, Clavijo-Alvarez JA. The epidemiology of mandibular fractures in the united states, part 1: a review of 13,142 cases from the US National Trauma Data Bank. J Oral Maxillofac Surg. 2015;73(12):2361–6.CrossRef Afrooz PN, Bykowski MR, James IB, Daniali LN, Clavijo-Alvarez JA. The epidemiology of mandibular fractures in the united states, part 1: a review of 13,142 cases from the US National Trauma Data Bank. J Oral Maxillofac Surg. 2015;73(12):2361–6.CrossRef
5.
go back to reference Beirne JC, Butler PE, Brady FA. Cervical spine injuries in patients with facial fractures: a 1-year prospective study. Int J Oral Maxillofac Surg. 1995;24(1 Pt 1):26–9.CrossRef Beirne JC, Butler PE, Brady FA. Cervical spine injuries in patients with facial fractures: a 1-year prospective study. Int J Oral Maxillofac Surg. 1995;24(1 Pt 1):26–9.CrossRef
6.
go back to reference Sinclair D, Schwartz M, Gruss J, McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med. 1988;6(2):109–12.CrossRef Sinclair D, Schwartz M, Gruss J, McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med. 1988;6(2):109–12.CrossRef
7.
go back to reference Cogbill TH, Moore EE, Meissner M, et al. The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma. 1994;37:473–9.CrossRef Cogbill TH, Moore EE, Meissner M, et al. The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma. 1994;37:473–9.CrossRef
8.
go back to reference Harrigan MR, Falola MI, Shannon CN, Westrick AC, Walters BC. Incidence and trends in the diagnosis of traumatic extracranial cerebrovascular injury in the nationwide inpatient sample database, 2003–2010. J Neurotrauma. 2014;31(11):1056–62.CrossRef Harrigan MR, Falola MI, Shannon CN, Westrick AC, Walters BC. Incidence and trends in the diagnosis of traumatic extracranial cerebrovascular injury in the nationwide inpatient sample database, 2003–2010. J Neurotrauma. 2014;31(11):1056–62.CrossRef
9.
go back to reference Grigorian A, Kabutey NK, Schubl S, de Virgilio C, Joe V, Dolich M, Elfenbein D, Nahmias J. Blunt cerebrovascular injury incidence, stroke-rate, and mortality with the expanded Denver criteria. Surgery. 2018;164(3):494–9.CrossRef Grigorian A, Kabutey NK, Schubl S, de Virgilio C, Joe V, Dolich M, Elfenbein D, Nahmias J. Blunt cerebrovascular injury incidence, stroke-rate, and mortality with the expanded Denver criteria. Surgery. 2018;164(3):494–9.CrossRef
10.
go back to reference Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO Jr, Shackford SR. Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma. 1990;30:1514–7.CrossRef Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO Jr, Shackford SR. Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma. 1990;30:1514–7.CrossRef
11.
go back to reference Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE Jr, Johnson JL, Moore JB, Burch JM. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139:540–5.CrossRef Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE Jr, Johnson JL, Moore JB, Burch JM. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139:540–5.CrossRef
12.
go back to reference Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178:517–22.CrossRef Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178:517–22.CrossRef
13.
go back to reference Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the eastern Association for the Surgery of trauma. J Trauma. 2010;68:471–7.PubMed Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the eastern Association for the Surgery of trauma. J Trauma. 2010;68:471–7.PubMed
14.
go back to reference Burlew CC, Biffl WL, Moore EE, Barnett CC, Johnson JL, Bensard DD. Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg. 2012;72:330–5.CrossRef Burlew CC, Biffl WL, Moore EE, Barnett CC, Johnson JL, Bensard DD. Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg. 2012;72:330–5.CrossRef
15.
go back to reference Morris C, Bebeau NP, Brockhoff H, Tandon R, Tiwana P. Mandibular fractures: an analysis of the epidemiology and patterns of injury in 4143 fractures. J Oral Maxillofac Surg. 2015;73(5):951.CrossRef Morris C, Bebeau NP, Brockhoff H, Tandon R, Tiwana P. Mandibular fractures: an analysis of the epidemiology and patterns of injury in 4143 fractures. J Oral Maxillofac Surg. 2015;73(5):951.CrossRef
16.
go back to reference Plaisier BR, Punjabi AP, Super DM, Haug RH. The relationship between facial fractures and death from neurologic injury. J Oral Maxillofac Surg. 2000;58(7):708–12.CrossRef Plaisier BR, Punjabi AP, Super DM, Haug RH. The relationship between facial fractures and death from neurologic injury. J Oral Maxillofac Surg. 2000;58(7):708–12.CrossRef
17.
go back to reference Kelts G, Maturo S, Couch ME, Schmalbach CE. Blunt cerebrovascular injury following craniomaxillofacial fractures: a systematic review. Laryngoscope. 2017;127(1):79–86.CrossRef Kelts G, Maturo S, Couch ME, Schmalbach CE. Blunt cerebrovascular injury following craniomaxillofacial fractures: a systematic review. Laryngoscope. 2017;127(1):79–86.CrossRef
18.
go back to reference Tveita IA, Madsen MRS, Nielsen EW. Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature. J Med Case Rep. 2017;11:148.CrossRef Tveita IA, Madsen MRS, Nielsen EW. Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature. J Med Case Rep. 2017;11:148.CrossRef
19.
go back to reference Weber CD, Lefering R, Kobbe P, Horst K, Pishnamaz M, Sellei RM, Hildebrand F, Pape HC, TraumaRegister DGU. Blunt cerebrovascular artery injury and stroke in severely injured patients: an international multicenter analysis. World J Surg. 2018;42(7):2043–53.CrossRef Weber CD, Lefering R, Kobbe P, Horst K, Pishnamaz M, Sellei RM, Hildebrand F, Pape HC, TraumaRegister DGU. Blunt cerebrovascular artery injury and stroke in severely injured patients: an international multicenter analysis. World J Surg. 2018;42(7):2043–53.CrossRef
20.
go back to reference Mundinger GS, Dorafshar AH, Gilson MM, Mithani SK, Manson PN, Rodriguez ED. Blunt-mechanism facial fracture patterns associated with internal carotid artery injuries: recommendations for additional screening criteria based on analysis of 4398 patients. Oral Maxillofac Surg. 2013;71(12):2092–100.CrossRef Mundinger GS, Dorafshar AH, Gilson MM, Mithani SK, Manson PN, Rodriguez ED. Blunt-mechanism facial fracture patterns associated with internal carotid artery injuries: recommendations for additional screening criteria based on analysis of 4398 patients. Oral Maxillofac Surg. 2013;71(12):2092–100.CrossRef
21.
go back to reference Vranis NM, Mundinger GS, Bellamy JL, Schultz BD, Banda A, Yang R, Dorafshar AH, Christy MR, Rodriguez ED. Extracapsular mandibular condyle fractures are associated with severe blunt internal carotid artery injury: analysis of 605 patients. Plast Reconstr Surg. 2015;136(4):811–21.CrossRef Vranis NM, Mundinger GS, Bellamy JL, Schultz BD, Banda A, Yang R, Dorafshar AH, Christy MR, Rodriguez ED. Extracapsular mandibular condyle fractures are associated with severe blunt internal carotid artery injury: analysis of 605 patients. Plast Reconstr Surg. 2015;136(4):811–21.CrossRef
Metadata
Title
Identifying risk factors of cerebrovascular injuries following blunt mandible fracture; a retrospective study from a national data base
Authors
Nasim Ahmed
Patricia Greenberg
Kayvon Haghighi
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01272-5

Other articles of this Issue 3/2021

European Journal of Trauma and Emergency Surgery 3/2021 Go to the issue