title: The pattern of combined maxillofacial and cervical spine fractures.
abstract: OBJECTIVE
  Prompt recognition of cervical fractures in patients with facial fractures is of prime importance, as failure to diagnose such injuries carries a significant risk of causing neurologic abnormalities, long-term disabilities, and even death. The aim of this retrospective case study is to describe the different patterns of combinations of maxillofacial and cervical spine (C-spine) injuries to provide guidance in diagnosis and care of patients with combined injuries.
  
  
  METHODS
  The trauma directory of 1 academic institution was searched for records of 701 patients admitted with cervical spine fractures between January 2000 and June 2006. Patients who did not sustain a facial fracture in addition to their C-spine fracture were excluded. The search was narrowed to 44 patients (6.26%) who presented with combined C-spine and facial fractures. Descriptive statistics were performed in which the frequencies of the variables were presented and then exploration of the interaction between the different variables was carried out.
  
  
  RESULTS
  A 6.28% incidence rate of combined C-spine and maxillofacial fractures is noted in this study. The most common cause of trauma was motor vehicle accidents (45.5%), followed by falls (36.4%). In regards to the types of maxillofacial fractures, 27.3% of the cases presented with isolated orbital fractures and 13.6% with isolated mandibular fractures. A total of 68.2% of the combined C-spine and facial fracture cases involved orbital fractures of some form. The most frequent level of C-spine fracture was isolated C2 fractures (31.8%) followed by isolated C4 and C6 fractures (6.8% each). When the mechanism of trauma were compared to the types of C-spine and maxillofacial fractures, falls were found to be the most frequent mechanism causing both isolated orbital and C2 fractures.
  
  
  CONCLUSIONS
  The rule of presuming that all patients with maxillofacial fractures have an unstable C-spine injury should stand. This should be emphasized in patients with orbital fractures and we plead for a higher index of suspicion for C-spine injuries in such patients.
authors.affiliation: Oral and Maxillofacial Surgery Department, Thomas Jefferson University Hospital, Philadelphia, PA, USA. basem_jamal@yahoo.com
authors.forename: Basem T
authors.initials: BT
authors.lastname: Jamal
authors.forename: Robert
authors.initials: R
authors.lastname: Diecidue
authors.forename: Akram
authors.initials: A
authors.lastname: Qutob
authors.forename: Akram
authors.initials: A
authors.lastname: Qutub
authors.forename: Murray
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D007572:Jaw Fractures / Q000150:complications* / Q000473:pathology; D008297:Male; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications* / Q000473:pathology; D015051:Zygomatic Fractures / Q000150:complications* / Q000473:pathology