title: Combat-related craniofacial and cervical injuries: a 5-year review from the British military.
abstract: BACKGROUND
  Recent international publications have noted a sustained increase in the incidence of head, face, and neck (HFN) wounds in comparison with total battle injuries from the 20th to the 21st century. The aim of this review was therefore to perform an analysis of the epidemiology of all HFN injuries sustained by British forces in Iraq and Afghanistan from March 1, 2003, to December 31, 2008.
  
  
  METHODS
  Descriptive injury data for this research were obtained from the Joint Theater Trauma Registry and overall battle injury and evacuation figures from the Defense Analytical and Statistical Agency.
  
  
  RESULTS
  During this period, 448 servicemen sustained injuries to their HFN. A total of 71% of HFN injuries were sustained in battle. Of all service personnel sustaining HFN injuries, 32% died before the field hospital and a further 6% died subsequently. A total of 73% of injuries required evacuation back to the United Kingdom, whereas 27% of injuries were managed definitively in the theater of operations. HFN injuries altogether were found in 29% of battle injuries between 2006 and 2008.
  
  
  CONCLUSIONS
  The individual incidences of head (15%) and face (19%) injuries in relation to total battle injuries, although greater than seen in previous United Kingdom conflicts, were only slightly higher than that seen by US forces. The incidence of neck injury alone in relation to total battle injuries of 11% in United Kingdom forces in comparison with 3% to 5% found in US forces warrants further investigation. This article also provides further evidence to support the existing published opinion of multiple international authors in the requirement to develop innovative methods of protecting the vulnerable HFN regions.
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham, UK.
authors.forename: John
authors.initials: J
authors.lastname: Breeze
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gibbons
authors.forename: Colin
authors.initials: C
authors.lastname: Shieff
authors.forename: Graham
authors.initials: G
authors.lastname: Banfield
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Bryant
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Midwinter
mesh_terms: D055826:Afghan Campaign 2001-; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005151:Facial Injuries / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008889:Military Personnel / Q000706:statistics & numerical data*; D019838:Neck Injuries / Q000453:epidemiology*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology