title: When to suspect head injury or cervical spine injury in maxillofacial trauma?
abstract: BACKGROUND
  The global status report of the World Health Organization (WHO) on road safety suggested that India is leading in road traffic accidents in the world. According to the report on road accidents in India in 2010 by the Transport Research Wing, Ministry of Road Transport and Highways, New Delhi, Kerala ranked third in accidents per lakh population and second in persons injured per lakh population. As the face, brain, and cervical spine are in close proximity with one another, associated injuries can be suspected. The aim of this study was to determine the relationship between the severity of head, cervical spine, and facial injury and incidence of facial injury in patients with head and/or cervical spine injury.
  
  
  METHODS
  A prospective cohort study was conducted over a period of one year. The study population included all patients having computed tomography (CT)-demonstrable head injury, radiographic evidence of cervical spine injury, and associated head or cervical spine injury with facial injury. Data were analyzed using the chi-square test using statistical package SPSS. A P value less than 0.05 was considered statistically significant.
  
  
  RESULTS
  Of 124 patients, 59 (47.6%) had facial injuries. As severity of head injury increased, the number of facial injuries decreased. Statistically, no significant association between facial and head injury was seen. A statistically significant association between dentoalveolar involvement and cervical spine injury was seen (P < 0.001). The proportion of injuries in patients with cervical spine injuries alone was significantly lower in the frontal (P = 0.001) and orbital (P = 0.004) regions and higher in the mandibular region (P = 0.010).
  
  
  CONCLUSIONS
  Midface injuries were more commonly associated with head injuries. Decreased facial involvement leads to increased severity of head injury. Simple injuries of the cervical spine were more commonly associated with facial injuries.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Dr. Z A Dental College, AMU, Aligarh, India.
authors.forename: Sajjad A
authors.initials: SA
authors.lastname: Rahman
authors.affiliation: Government Dental College, Department of Oral and Maxillofacial Surgery, Kozhikode, Kerala, India.
authors.forename: Soumithran
authors.initials: S
authors.lastname: Chandrasala
keywords: Cervical spine injury; head injury; maxillofacial injury
references.citation: Int J Oral Maxillofac Surg. 1998 Aug;27(4):286-9
references.pmid: 9698176
references.citation: Am Surg. 2002 May;68(5):477-81
references.pmid: 12017150
references.citation: Int J Oral Maxillofac Surg. 1995 Dec;24(6):409-12
references.pmid: 8636636
references.citation: Int J Oral Maxillofac Surg. 1999 Dec;28(6):424-8
references.pmid: 10609743
references.citation: J Trauma. 1994 Nov;37(5):807-11
references.pmid: 7966480
references.citation: J Trauma. 2010 Mar;68(3):587-92
references.pmid: 19996802
references.citation: Br J Oral Maxillofac Surg. 2007 Dec;45(8):637-9
references.pmid: 17524534
references.citation: J Neurosurg. 1987 Apr;66(4):542-7
references.pmid: 3559719
references.citation: N Z Med J. 2004 Sep 10;117(1201):U1045
references.pmid: 15476005
references.citation: Plast Reconstr Surg. 1979 Jan;63(1):26-30
references.pmid: 432322
references.citation: Arch Otolaryngol Head Neck Surg. 1997 Dec;123(12):1304-7
references.pmid: 9413358
references.citation: Ann Emerg Med. 1992 Jun;21(6):719-22
references.pmid: 1590614
references.citation: Accid Anal Prev. 1992 Apr;24(2):187-92
references.pmid: 1558627
references.citation: Arch Surg. 1999 Jan;134(1):14-7
references.pmid: 9927123
references.citation: Med Trop (Mars). 2010 Apr;70(2):172-4
references.pmid: 20486356
references.citation: J Oral Maxillofac Surg. 1994 Jul;52(7):729-33
references.pmid: 8006737
references.citation: Br J Oral Maxillofac Surg. 1997 Aug;35(4):243-5
references.pmid: 9291261
references.citation: J Oral Maxillofac Surg. 2006 Jul;64(7):1023-9
references.pmid: 16781334
references.citation: J Trauma. 2001 Jan;50(1):41-5
references.pmid: 11231667
references.citation: Plast Reconstr Surg. 2009 Apr;123(4):1293-1301
references.pmid: 19337097
references.citation: Plast Reconstr Surg. 2008 Jan;121(1):201-208
references.pmid: 18176222
references.citation: J Trauma. 1989 Sep;29(9):1276-8
references.pmid: 2769811
references.citation: Plast Reconstr Surg. 1967 Nov;40(5):415-25
references.pmid: 6074141
references.citation: J Emerg Med. 1988 Mar-Apr;6(2):109-12
references.pmid: 3385170
references.citation: J Craniomaxillofac Surg. 2003 Feb;31(1):51-61
references.pmid: 12553928
references.citation: J Oral Maxillofac Surg. 2009 Mar;67(3):559-62
references.pmid: 19231780
references.citation: J Oral Maxillofac Surg. 1992 Mar;50(3):218-22
references.pmid: 1542064
references.citation: J Oral Maxillofac Surg. 1990 Sep;48(9):926-32
references.pmid: 2395044
references.citation: J Trauma. 1985 Jan;25(1):90-3
references.pmid: 3965740
references.citation: Ann Emerg Med. 1985 Oct;14(10):973-5
references.pmid: 4037477
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Oct;92(4):370-6
references.pmid: 11598569
references.citation: J Trauma. 1993 Apr;34(4):549-53; discussion 553-4
references.pmid: 8487340
references.citation: Am J Emerg Med. 1984 Jul;2(4):333-5
references.pmid: 6518036
references.citation: J Trauma. 2000 Sep;49(3):425-32
references.pmid: 11003318
references.citation: Ann Emerg Med. 1988 Jan;17(1):6-9
references.pmid: 3337417