A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries

Cervical spine injury complicating facial trauma: incidence and management

PURPOSE

To review the impact of concomitant cervical spine injury on the management of facial fractures in a tertiary care institution via a retrospective chart review.

PATIENTS AND METHODS

Within the past 10 years, 1,750 consecutive patients presented to our institution with facial fractures. Thirty-two had concomitant cervical spine injury. Five were transferred or died before treatment. The remaining 27 charts were reviewed in detail.

RESULTS

The incidence of cervical spine injury among patients with facial fractures in our study was 1.8%. There were no treatment delays attributed to these injuries. Of note was the inaccuracy of lateral cervical spine films in 9 of 27 cases (33%).

CONCLUSION

Although uncommon, cervical spine injury must be thoroughly ruled out before evaluation and management of facial trauma. Concomitant cervical spine injury should not delay appropriate and timely treatment of facial fractures because adequate means of intraoperative stabilization are readily available.

Cervical spine injuries in patients with facial fractures: a 1-year prospective study

A total of 582 consecutive patients with facial fractures were investigated prospectively for evidence of a concomitant cervical spine injury. Of them, 1.04% (6) were found to have a cervical spine injury, all having occurred in road traffic accidents. Only two of the injuries were diagnosable on standard, three-view, plain cervical spine radiographs. Four were diagnosable from computerized tomography scan, while the remaining two required stress views under radiographic screening for definitive diagnosis.

Head, facial, and clavicular trauma as a predictor of cervical-spine injury

STUDY HYPOTHESIS

The American College of Surgeons teaches that "trauma occurring above the clavicle should raise a high suspicion for a potential cervical spine injury." In this study, we investigated the association of head, facial, and clavicular trauma with cervical-spine and cord injury.

METHODS

The records of 5,021 consecutive trauma patients admitted to a level I regional trauma center during a three and one-half year period were reviewed retrospectively. The incidence rates of head, facial, clavicle, cervical spine, and cervical cord injuries were recorded. Glasgow Coma Scores (GCS) were obtained on all patients. Statistical analysis using multiple logistic regression and chi 2 analysis were performed to determine the relationship between traumatic injury above the clavicle and cervical spine and cord injury.

RESULTS

Head-injured patients had no greater incidence of cervical-spine injury than did non-head-injured patients (4.76% vs 4.37%, P = .52) but were found to have significantly fewer spinal cord injuries (1.5% vs 2.3%, P = .048). There was no difference in incidence of cervical-spine injuries between patients with and those without facial injuries (4.2% vs 4.6%, P = .61). However, there were significantly fewer cord injuries among patients with facial injuries (0.75% vs 2.2%, P = .01). The presence or absence of clavicular fracture was not associated with a significant increase in cervical spine (6.9% vs 4.4%, P = 11) or cervical cord injuries (1.6% vs 2.0%, P = .68). A GCS of less than 14 was associated with a higher incidence of cervical-spine injury than was a GCS of 14 or more in both head-injured (6.7% vs 3.9%, P = .007) and non-head-injured patients (12.2% vs 5.9%, P = .002). There was a greater incidence of cervical cord injury among patients with a GCS of less than 14 than in those with a GCS of 14 or more in both the head-injured (2.2% vs 1.2%, P = .09) and non-head-injured (8.8% vs 2.7%, P less than .0001) groups.

CONCLUSION

Trauma to the head, face, and clavicle is not associated with a higher incidence of cervical-spine or cord injury. Physiologic parameters such as the GCS appear to be more accurate predictors of cervical spine or cord injury than mere evidence of trauma occurring above the clavicle.

Cervical spine injuries in blunt trauma patients requiring emergent endotracheal intubation

Airway management in the blunt trauma patient is complicated by the potential for causing or exacerbating an injury to the cervical cord if an unstable cervical fracture is present. The records of 987 blunt trauma patients who required emergent endotracheal intubation over a 5-year period were retrospectively reviewed to determine the incidence and type of cervical spine injury and the incidence of injury based on airway management. Sixty of the patients (6.1%) had a cervical fracture; 53 were potentially unstable injuries by radiographic criteria. Twenty patients had neurologic deficits prior to intubation. Twenty-six patients with unstable injuries were intubated orally, 25 nasally, and two by cricothyrotomy. One patient developed a neurologic deficit after nasotracheal intubation. Because of a possible selection bias in which severely injured patients were preferentially referred to this trauma center, the true incidence of cervical spine injuries may be lower than the 6.1% we found. The authors conclude that the incidence of serious cervical spine injury in a very severely injured population of blunt trauma patients is relatively low, and that commonly used methods of precautionary airway management rarely lead to neurologic deterioration.