Pattern of Cervical Spine Injury in Patients with a Facial Fracture

Kim, Gab Teug

Abstract

PURPOSE
Facial fractures are highly associated with cervical spine or spinal cord injuries. Nevertheless, disagreement exists as to the actual incidence of cervical spinal trauma in conjunction with various facial fracture patterns. The purpose of this study was to evaluate the incidence of cervical spine injuries associated with various types of facial fractures.
METHODS
A retrospective review from 2003 to 2009 was performed on 4440 patients with facial fractures who presented to the emergency room of our hospital. Facial fractures were grouped into thirds. Cervical spine injuries were divided into one of two groups including upper cervical injuries (C0-C2) and lower cervical injuries (C3-C7) and included fractures, dislocation, and disc herniation with or without neurological deficits. The chi-square test and multivariate logistic regression analyses were used to identify associations between facial fractures and cervical spine injuries.
RESULTS
Among all patients with facial fractures, 80(1.85%) also had cervical spine injuries. Independent risk factors for cervical spine injury in patients with facial fracture were male gender (odds ratio [OR]=2.0), high velocity mechanism of injury (OR=4.0), and upper-third (OR=2.8) or combined facial fractures (OR=1.8). Cervical spine injuries increased in patients with high-force facial fractures. Fractures of the upper face were associated with an increased likelihood of lower cervical spine injuries and lower-third facial fractures were associated with an increased likelihood of having an upper cervical spine injury.
CONCLUSION
Facial fractures were commonly associated with cervical spine injuries. The cervical spine must be examined carefully whenever facial injuries are present.