Do facial fractures protect the brain or are they a marker for severe head injury?

Facial fractures (FF) have been suggested to protect the brain from severe injury. However, others have stated that facial fractures are a marker for increased risk of brain injury. The aim of this study is to evaluate the association between facial fractures, brain injury, and functional outcome. A retrospective review of our prospective trauma database was performed for blunt trauma patients during a 7-year period (January 1993 through December 1999) at the University of Louisville Hospital. We identified 7324 blunt trauma patients at a Level 1 trauma center. Severity of head injury in patients with and without FF was compared. The severity of brain injury was evaluated by admission Glasgow Coma Score (GCS) as well as specific head, neck, cervical spine, and face Acute Injury Score (AIS). Length of intensive care unit (ICU) stay, hospital stay, and Functional Independence Measures (FIM) score were also identified. A total of 1068 (14.6%) patients were diagnosed with FF; of these 848 (79.4%) patients suffered some form of brain injury by CT abnormality, clinical examination, or both. A total of 2192 patients were treated for head injury without FF; 220 patients were treated for FF without head injury. FF with traumatic brain injury (TBI) were found to occur significantly greater than FFs without TBI (P < 0.001). The mean GCS on admission for FF with head injury was 12, which was similar to that of patients with head injury alone with a GCS of 10 but was significantly less than that of patients with FF alone with a GCS of 15 (P < 0.05). Injury Severity Score for patients with FF and head injury was significantly worse compared with patients with head injury alone and those with FF alone (P < 0.0001). Mean ICU stay and hospital stay were similar for all three groups (ranges 3-6 and 6-12 days); and were not significant (P < 0.06). FIM score was significantly lower for patients with FF and head injury compared with FF alone (P = 0.0003) and similar to that of patients with head injury. FF were found to have a significantly greater incidence of TBI. FF with TBI had a similar severity of head injury when compared with patients with head injury alone by demonstrating similar GCS, AIS of the head and neck, and early functional recovery. This analysis does not support the hypothesis that the face provides a protective effect for the brain and therefore leading to a more favorable short-term outcome. Thus patients with facial fractures should be treated with the same caution as patients with significant blunt head trauma.