title: Ten years of war: a characterization of craniomaxillofacial injuries incurred during operations Enduring Freedom and Iraqi Freedom.
abstract: BACKGROUND
  Improved armor and battlefield medicine have led to better survival in the wars in Iraq and Afghanistan than any previous ones. Increased frequency and severity of craniomaxillofacial injuries have been proposed. A comprehensive characterization of the injury pattern sustained during this 10-year period to the craniomaxillofacial region is needed to improve our understanding of these unique injuries, to optimize the treatment for these patients, and to potentially direct strategic development of protective equipment in the future.
  
  
  METHODS
  The Joint Theater Trauma Registry was queried from October 19, 2001, to March 27, 2011, covering operations Enduring Freedom and Iraqi Freedom for battle injuries to the craniomaxillofacial region, including patient demographics and mechanism of injury. Injuries were classified according to type (wounds, fractures, burns, vascular injuries, and nerve injuries) using DRG International Classification of Diseases-9th Rev. diagnosis codes.
  
  
  RESULTS
  In this 10-year period, craniomaxillofacial battle injuries to the head and neck were found in 42.2% of patients evacuated out of theater. There is a high preponderance of multiple wounds and open fractures in this region. The primary mechanism of injury involved explosive devices, followed by ballistic trauma.
  
  
  CONCLUSIONS
  Modern combat, characterized by blast injuries, results in higher than previously reported incidence of injury to the craniomaxillofacial region.
  
  
  METHODS
  Epidemiologic study, level IV.
authors.affiliation: Dental and Trauma Research Detachment, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. rodney.k.chan@us.army.mil
authors.forename: Rodney K
authors.initials: RK
authors.lastname: Chan
authors.forename: Arlene
authors.initials: A
authors.lastname: Siller-Jackson
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Verrett
authors.forename: Jesse
authors.initials: J
authors.lastname: Wu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hale
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000453:epidemiology*; D016208:Databases, Factual; D005151:Facial Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality / Q000706:statistics & numerical data; D008437:Maxilla / Q000293:injuries*; D008889:Military Personnel / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012887:Skull Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014857:Warfare; D055815:Young Adult