# Patterns and Outcomes of Craniomaxillofacial Trauma in Puerto Rico: Insights From a Five-Year Retrospective Study

## TL;DR

This study is the first to analyze craniomaxillofacial trauma in Puerto Rico, finding that men and adults are most affected, with motor vehicle accidents and falls as common causes.

## Contribution

This is the first comprehensive epidemiological study of craniomaxillofacial trauma in Puerto Rico.

## Key findings

- Facial fractures were more common than cranial fractures in the studied population.
- Motor vehicle accidents and falls were the leading causes of CMF trauma.
- Patients with fractures had worse outcomes, as indicated by higher severity scores.

## Abstract

Background

Craniomaxillofacial (CMF) trauma is a significant problem in the United States, with estimated costs of nearly one billion dollars annually. Facial fractures occur based on factors such as facial structure, the direction and intensity of the impact, and the mechanism of injury. The most frequent facial fractures include the nose, orbits, zygomatic complex, mandible, maxilla, and frontal bone. Additionally, demographic, social, cultural, and environmental factors can contribute to particular trauma mechanisms like falls and motor vehicle accidents (MVAs), leading to different CMF injury rates among populations. Overall, CMF traumas have a significant potential for morbidity and mortality. This study aims to provide the first overview of the prevalence of CMF trauma in Puerto Rico.

Methods

This retrospective study includes patients aged 0-100 who presented with CMF trauma from 2018 to 2022 to the only trauma center in Puerto Rico. Demographic and clinical data were collected, including the mechanism of injury, craniofacial structures involved, treatment, and outcomes. Frequencies of demographic and clinical data were documented, and statistical analysis using one-way ANOVA and t-tests was performed.

Results

A total of 1,102 patients (83.1% male and 16.4% female) with CMF injuries were included. The mean age of the group was 40.67 years. The most common mechanisms were non-car-related MVA (23.6%), car-related MVA (22.9%), pedestrian accidents (18.4%), falls (15.9%), and gunshot wounds (10.4%). Cranial fractures occurred in 32.7% of patients with the following affected regions: temporal (16.2%), frontal (10.6%), parietal (7.8%), and occipital (5.3%). Facial fractures occurred in 70% of patients with the following affected regions: middle face including maxilla, nose, zygoma, and orbits (61.8%), lower face including mandible (17.7%), and upper face including frontal bone (9%). Approximately 19.8% of patients with CMF fractures underwent surgical management. The mortality rate in the cohort was 11.8%. The Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) were significantly worse in patients with cranial (p < 0.001) and/or facial (p < 0.001) fractures when compared to patients who suffered from CMF traumas without fractures.

Conclusion

To our knowledge, this is the first study characterizing CMF traumas in Puerto Rico. The majority of the affected patients were male and belonged to the adult population. Common etiologies of injury were comparable to others reported in the literature, including MVA, falls, and gunshot wounds. Facial fractures were more prevalent than cranial fractures in our cohort. Patients with high-severity injuries were more likely to be managed surgically. By establishing the epidemiological picture of CMF traumas in Puerto Rico, public health and clinical efforts may be employed to allow for improved patient outcomes.