Maxillofacial injuries in severely injured patients after road traffic accidents—a retrospective evaluation of the TraumaRegister DGU® 1993–2014

  • Sebastian Pietzka
  • Peer W. Kämmerer
  • Silke Pietzka
  • Alexander Schramm
  • Lorenz Lampl
  • Rolf Lefering
  • Dan Bieler
  • Martin KullaEmail author
Original Article



It was the aim of the study to analyse the prevalence of maxillofacial trauma (MFT) in severely injured patients after road traffic accidence (RTA) and to investigate associated factors.

Materials and methods

In a retrospective study, data from patients after RTA by the TraumaRegister DGU® from 1993 to 2014 were evaluated for demographical and injury characteristics. The predictor variable was mechanism of injury and the outcome variables were type of injury, severity and hospital resources utilization.


During the investigation period, n = 62,196 patients were enclosed with a prevalence of maxillofacial injuries of 20.3% (MFT positive). The injury severity score of MFT-positive patients was higher than in the MTF-negative subgroup (27 ± 12.8 vs. 23.0 ± 12.7). If MFT positive, 39.8% show minor, 37.1% moderate, 21.5% serious and 1.6% severe maxillofacial injuries. Injuries of the midface occurred in 60.3% of MTF-positive patients. A relevant blood loss (> 20% of total blood volume) occurred in 1.9%. MFT-positive patients had a higher coincidence with cervical spine fractures (11.3% vs. 7.8%) and traumatic brain injuries (62.6% vs. 34.8%) than MFT-negative patients. There was a noticeable decrease in the incidence of facial injuries in car/truck drivers during the study period.


Every 5th patient after RTA shows a MFT and the whole trauma team must be aware that this indicates a high prevalence of traumatic brain and cervical spine injuries.

Clinical relevance

Even if sole injuries of the face are seldom life threatening, maxillofacial expertise in interdisciplinary trauma centres is strongly recommended.


Maxillofacial injury Trauma Epidemiology Road traffic accident 



The authors state that parts of this article are based on a doctoral dissertation that will be submitted to the Medical School of the University of Ulm by Silke Pietzka.

Compliance with ethical standards

Conflict of interest

Sebastian Pietzka declares that he has no conflict of interest. Peer W. Kämmerer declares that he has no conflict of interest. Silke Pietzka declares that she has no conflict of interest. Alexander Schramm declares that he has no conflict of interest. Lorenz Lampl declares that he has no conflict of interest. Rolf Lefering declares that he has no conflict of interest. Dan Bieler declares that he has no conflict of interest. Martin Kulla declares that he has no conflict of interest.

Ethical approval

The present study has been approved by the Ethic Committee of the Medical School of the University of Ulm (positive Vote 17th December 2017). All procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Jin Z, Jiang X, Shang L (2014) Analysis of 627 hospitalized maxillofacial-oral injuries in Xi'an, China. Dent Traumatol 30:147–153. CrossRefPubMedGoogle Scholar
  2. 2.
    Yokoyama T, Motozawa Y, Sasaki T, Hitosugi M (2006) A retrospective analysis of oral and maxillofacial injuries in motor vehicle accidents. J Oral Maxillofac Surg 64:1731–1735. CrossRefPubMedGoogle Scholar
  3. 3.
    Ramli R, Oxley J, Noor FM, Abdullah NK, Mahmood MS, Tajuddin AK, McClure R (2014) Fatal injuries among motorcyclists in Klang Valley, Malaysia. J Forensic Legal Med 26:39–45. CrossRefGoogle Scholar
  4. 4.
    Schneider D, Kämmerer PW, Schon G, Dinu C, Radloff S, Bschorer R (2015) Etiology and injury patterns of maxillofacial fractures from the years 2010 to 2013 in Mecklenburg-Western Pomerania, Germany: a retrospective study of 409 patients. J Craniomaxillofac Surg 43:1948–1951. CrossRefPubMedGoogle Scholar
  5. 5.
    Nobrega LM, Cavalcante GM, Lima MM, Madruga RC, Ramos-Jorge ML, d'Avila S (2014) Prevalence of facial trauma and associated factors in victims of road traffic accidents. Am J Emerg Med 32:1382–1386. CrossRefPubMedGoogle Scholar
  6. 6.
    Dempf R, Hausamen JE (2000) [Fractures of the facial skull) Gesichtsschädelfrakturen. Unfallchirurg 103:301–313CrossRefPubMedGoogle Scholar
  7. 7.
    Esmer E, Delank KS, Siekmann H, Schulz M, Derst P (2016) Facial injuries in polytrauma - which injuries can be expected? A retrospective evaluation from the TraumaRegister DGU(R). Notfall Rettungsmed 19:92–98CrossRefGoogle Scholar
  8. 8.
    Rothweiler R, Bayer J, Zwingmann J, Suedkamp NP, Kalbhenn J, Schmelzeisen R, Gutwald R (2018) Outcome and complications after treatment of facial fractures at different times in polytrauma patients. J Craniomaxillofac Surg 46:283–287. CrossRefPubMedGoogle Scholar
  9. 9.
    Reich W, Surov A, Eckert AW (2016) Maxillofacial trauma - underestimation of cervical spine injury. J Craniomaxillofac Surg 44:1469–1478. CrossRefPubMedGoogle Scholar
  10. 10.
    Einy S, Abdel Rahman N, Siman-Tov M, Aizenbud D, Peleg K (2016) Maxillofacial trauma following road accidents and falls. J Craniofac Surg 27:857–861. CrossRefPubMedGoogle Scholar
  11. 11.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. CrossRefGoogle Scholar
  12. 12.
    Ruchholtz S, Lefering R, Lewan U, Debus F, Mand C, Siebert H, Kuhne CA (2014) Implementation of a nationwide trauma network for the care of severely injured patients. J Trauma Acute Care Surg 76:1456–1461. CrossRefPubMedGoogle Scholar
  13. 13.
    Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B (2014) Update of the trauma risk adjustment model of the TraumaRegister DGU: the revised injury severity classification, version II. Crit Care 18:476. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Wirtz M (2004) On the problem of missing data: how to identify and reduce the impact of missing data on findings of data analysis. Rehabilitation (Stuttg) 43:109–115. CrossRefGoogle Scholar
  15. 15.
    O'Connor RC, Shakib K, Brennan PA (2015) Recent advances in the management of oral and maxillofacial trauma. Br J Oral Maxillofac Surg 53:913–921. CrossRefPubMedGoogle Scholar
  16. 16.
    Rashid A, Eyeson J, Haider D, van Gijn D, Fan K (2013) Incidence and patterns of mandibular fractures during a 5-year period in a London teaching hospital. Br J Oral Maxillofac Surg 51:794–798. CrossRefPubMedGoogle Scholar
  17. 17.
    Caldas IM, Magalhaes T, Afonso A, Matos E (2008) Orofacial damage resulting from road accidents. Dent Traumatol 24:410–415. CrossRefPubMedGoogle Scholar
  18. 18.
    Manan M, Varhelyi A (2012) Motorcycle fatalities in Malaysia. IATSS Res 36:30–39CrossRefGoogle Scholar
  19. 19.
    Corazza M, Trincone S, Virgili A (2004) Effects of airbag deployment: lesions, epidemiology, and management. Am J Clin Dermatol 5:295–300CrossRefPubMedGoogle Scholar
  20. 20.
    Huber CD, Lee JB, Yang KH, King AI (2005) Head injuries in airbag-equipped motor vehicles with special emphasis on AIS 1 and 2 facial and loss of consciousness injuries. Traffic Inj Prev 6:170–174. CrossRefPubMedGoogle Scholar
  21. 21.
    Al-Khateeb T, Abdullah FM (2007) Craniomaxillofacial injuries in the United Arab Emirates: a retrospective study. J Oral Maxillofac Surg 65:1094–1101. CrossRefPubMedGoogle Scholar
  22. 22.
    Moafian G, Aghabeigi MR, Heydari ST, Hoseinzadeh A, Lankarani KB, Sarikhani Y (2013) An epidemiologic survey of road traffic accidents in Iran: analysis of driver-related factors. Chin J Traumatol 16:140–144PubMedGoogle Scholar
  23. 23.
    Hogg NJ, Stewart TC, Armstrong JE, Girotti MJ (2000) Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada, between 1992 and 1997. J Trauma 49:425–432CrossRefPubMedGoogle Scholar
  24. 24.
    Kuhne CA, Krueger C, Homann M, Mohr C, Ruchholtz S (2007) Epidemiology and management in emergency room patients with maxillofacial fractures. Mund Kiefer Gesichtschir 11:201–208. CrossRefPubMedGoogle Scholar
  25. 25.
    Joos U, Piffko J, Meyer U (2001) Treatment of frontobasal trauma and polytrauma. Mund Kiefer Gesichtschir 5:86–93. CrossRefPubMedGoogle Scholar
  26. 26.
    van Hout WM, Van Cann EM, Abbink JH, Koole R (2013) An epidemiological study of maxillofacial fractures requiring surgical treatment at a tertiary trauma Centre between 2005 and 2010. Br J Oral Maxillofac Surg 51:416–420. CrossRefPubMedGoogle Scholar
  27. 27.
    Walker TW, Donnellan J, Byrne S, McArdle N, Kerin MJ, McCann PJ (2012) West of Ireland facial injury study. Part 2. Br J Oral Maxillofac Surg 50:e99–e103. CrossRefPubMedGoogle Scholar
  28. 28.
    Tsang KK, Whitfield PC (2012) Traumatic brain injury: review of current management strategies. Br J Oral Maxillofac Surg 50:298–308. CrossRefPubMedGoogle Scholar
  29. 29.
    Aladelusi T, Akinmoladun V, Olusanya A, Akadiri O, Fasola A (2014) Analysis of road traffic crashes-related maxillofacial injuries severity and concomitant injuries in 201 patients seen at the UCH, Ibadan. Craniomaxillofac Trauma Reconstr 7:284–289. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Haug RH, Savage JD, Likavec MJ, Conforti PJ (1992) A review of 100 closed head injuries associated with facial fractures. J Oral Maxillofac Surg 50:218–222CrossRefPubMedGoogle Scholar
  31. 31.
    Surgeons ACo (2012) American College of Surgeons Committee on trauma: advanced trauma life support(R) student course manual ChicagoGoogle Scholar
  32. 32.
    Pehle B, Kuehne CA, Block J, Waydhas C, Taeger G, Nast-Kolb D, Ruchholtz S (2006) The significance of delayed diagnosis in multiply tramatised patients. A study of 1187 trauma room patients. Unfallchirurg 109:964–974CrossRefPubMedGoogle Scholar
  33. 33.
    LewisVL J, Manson PN, Morgan RF, Cerullo LJ, Meyer PR Jr (1985) Facial injuries associated with cervical fractures: recognition, patterns, and management. J Trauma 25:90–93CrossRefGoogle Scholar
  34. 34.
    Jamal BT, Diecidue R, Qutob A, Cohen M (2009) The pattern of combined maxillofacial and cervical spine fractures. J Oral Maxillofac Surg 67:559–562. CrossRefPubMedGoogle Scholar
  35. 35.
    Mulligan RP, Mahabir RC (2010) The prevalence of cervical spine injury, head injury, or both with isolated and multiple craniomaxillofacial fractures. Plast Reconstr Surg 126:1647–1651CrossRefPubMedGoogle Scholar
  36. 36.
    Sargent LA, Rogers GF (1999) Nasoethmoid orbital fractures: diagnosis and management. J Craniomaxillofac Trauma 5:19–27PubMedGoogle Scholar
  37. 37.
    Scholz R, Scholz F, Sudasch G, Schobel G, Schober C (1991) Delayed primary management of midfacial fractures. Fortschr Kiefer Gesichtschir 36:79–80PubMedGoogle Scholar
  38. 38.
    Christie B, Block L, Ma Y, Wick A, Afifi A (2018) Retrobulbar hematoma: a systematic review of factors related to outcomes. J Plast Reconstr Aesthet Surg 71:155–161. CrossRefPubMedGoogle Scholar
  39. 39.
    Nastro Siniscalchi E, Catalfamo L, Pitrone A, Papa R, Fama F, Lo Giudice G, Cervino G, Cicciu M, De Ponte FS (2016) Traumatic Pseudoaneurysm of the internal maxillary artery: arare life-threatening hemorrhage as a complication of maxillofacial fractures. Case Rep Med 2016:9168429. CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Debus F, Lefering R, Frink M, Kuhne CA, Mand C, Bucking B, Ruchholtz S (2015) Numbers of severely injured patients in Germany. A retrospective analysis from the DGU (German Society for Trauma Surgery) trauma registry. Dtsch Arztebl Int 112:823–829. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG, and Working Group on Polytrauma of the German Trauma S (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461. CrossRefPubMedGoogle Scholar
  42. 42.
    Palm HG, Kulla M, Wettberg M, Lefering R, Friemert B, Lang P, TraumaRegistrer DGU (2017) Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-Centre study based on the trauma registry of the German trauma society (TraumaRegister DGU((R))). Eur J Trauma Emerg Surg 44:759–766. CrossRefPubMedGoogle Scholar
  43. 43.
    Ringdal KG, Skaga NO, Hestnes M, Steen PA, Roislien J, Rehn M, Roise O, Kruger AJ, Lossius HM (2013) Abbreviated injury scale: not a reliable basis for summation of injury severity in trauma facilities. Injury 44:691–699. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cranio-Maxillo-Facial-SurgeryGerman Armed Forces Hospital UlmUlmGermany
  2. 2.Department of Cranio-Maxillo-Facial-SurgeryUniversity Medical Centre MainzMainzGermany
  3. 3.Department of Dental Care and Centre for Dental SpecialtiesGerman Armed Forces Hospital UlmUlmGermany
  4. 4.Department of Cranio-Maxillo-Facial-SurgeryUniversity Hospital UlmUlmGermany
  5. 5.Department of Anaesthesiology and Intensive Care MedicineGerman Armed Forces Hospital of UlmUlmGermany
  6. 6.Institute for Research in Operative Medicine (IFOM)Witten/Herdecke UniversityWittenGermany
  7. 7.Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn MedicineGerman Armed Forces Central Hospital KoblenzKoblenzGermany
  8. 8.Department of Anaesthesiology and Intensive Care Medicine, Emergency Medicine Section, HEMS Christoph 22German Armed Forces Hospital of UlmUlmGermany

Personalised recommendations