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Background <p>The link between facial fracture complexity and risk of traumatic brain injury (TBI) remains debated. Panfacial fractures may dissipate impact energy across multiple fracture lines, reducing neurocranial transmission, but could also indicate high energy trauma.</p> Methods <p>A retrospective cohort study of 650 consecutive patients (≥ 16 years) with CT confirmed maxillofacial fractures, admitted to a tertiary trauma centre in North-Western India (July 2023–June 2025), was undertaken. Panfacial fractures involved ≥ 3 facial subunits; isolated fractures involved one subunit. Data included demographics, aetiology, helmet use, Facial Injury Severity Scale (FISS) scores, and TBI diagnoses (CT-documented or clinical concussion). Diffuse axonal injury (DAI) was recorded in MRI subsets. Multivariable logistic regression estimated adjusted odds ratios (aORs).</p> Results <p>Of 650 patients (95% male; mean age 28.5 ± 7.2 years), 180 (27.7%) sustained panfacial and 470 (72.3%) isolated fractures. Road traffic accidents (RTAs) caused 75% of cases; 60% of two-wheeler riders with documented status were unhelmeted. Mean FISS was higher in panfacial (10.2 ± 2.1) than isolated fractures (3.8 ± 1.5; <i>p</i> &lt; 0.001). TBI incidence was 30.9% overall, lower in panfacial (20%) than isolated fractures (35%; <i>p</i> = 0.002). Adjusted analysis confirmed panfacial fractures reduced TBI risk (aOR 0.47, 95% CI 0.31–0.72, <i>p</i> = 0.001). Two-wheeler RTAs (aOR1.82, <i>p</i> = 0.003) and helmet non-use (aOR 2.10, <i>p</i> &lt; 0.001) increased risk. MRI in 45 cases detected DAI in 9 (20%).</p> Conclusion <p>Panfacial fractures were associated with lower TBI incidence than isolated fractures, supporting the energy dissipation hypothesis. Isolated fractures and helmet non-use warrant heightened vigilance. Helmet enforcement remains a critical public health need.</p>

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Energy Dissipation and Traumatic Brain Injury in Maxillofacial Trauma: A Retrospective Cohort Analysis of Panfacial and Isolated Fractures in North-Western India

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Chandrashekhar Chattopadhyay,
  • Vikas Deo,
  • Charu Chouhan,
  • Mamta Patel,
  • Ayush Garg,
  • Priti Airun

摘要

Background

The link between facial fracture complexity and risk of traumatic brain injury (TBI) remains debated. Panfacial fractures may dissipate impact energy across multiple fracture lines, reducing neurocranial transmission, but could also indicate high energy trauma.

Methods

A retrospective cohort study of 650 consecutive patients (≥ 16 years) with CT confirmed maxillofacial fractures, admitted to a tertiary trauma centre in North-Western India (July 2023–June 2025), was undertaken. Panfacial fractures involved ≥ 3 facial subunits; isolated fractures involved one subunit. Data included demographics, aetiology, helmet use, Facial Injury Severity Scale (FISS) scores, and TBI diagnoses (CT-documented or clinical concussion). Diffuse axonal injury (DAI) was recorded in MRI subsets. Multivariable logistic regression estimated adjusted odds ratios (aORs).

Results

Of 650 patients (95% male; mean age 28.5 ± 7.2 years), 180 (27.7%) sustained panfacial and 470 (72.3%) isolated fractures. Road traffic accidents (RTAs) caused 75% of cases; 60% of two-wheeler riders with documented status were unhelmeted. Mean FISS was higher in panfacial (10.2 ± 2.1) than isolated fractures (3.8 ± 1.5; p < 0.001). TBI incidence was 30.9% overall, lower in panfacial (20%) than isolated fractures (35%; p = 0.002). Adjusted analysis confirmed panfacial fractures reduced TBI risk (aOR 0.47, 95% CI 0.31–0.72, p = 0.001). Two-wheeler RTAs (aOR1.82, p = 0.003) and helmet non-use (aOR 2.10, p < 0.001) increased risk. MRI in 45 cases detected DAI in 9 (20%).

Conclusion

Panfacial fractures were associated with lower TBI incidence than isolated fractures, supporting the energy dissipation hypothesis. Isolated fractures and helmet non-use warrant heightened vigilance. Helmet enforcement remains a critical public health need.