The facial skeleton: Armor to the brain?

Background: With the development of urban setting worldwide, the major issue of concern is the increase in the mortality rate in the population due to road traffic accidents. The face, being the most exposed region is susceptible to injuries and maybe associated with injuries to the adjacent neuro-cranium. The literature has conflicting views on the relationship between facial fractures and head injuries with some authors opining that the facial skeleton cushions the brain while some other authors claim that the facial fractures act as indicators for head injuries. Objectives: To analyze the correlation between the facial fractures and head injuries and to assess if the facial skeleton acts to protect the brain from injury. Patients and Methods: A prospective study that included patients who reported to the emergency department of Basaveswar Teaching and General Hospital, Gulbarga, during 2 years, between August 2013 and July 2015 was conducted. A total of 100 patients with facial fractures were enrolled in the study. Results: Head injuries were sustained by 51 patients in the study. Maximum number of patients was in the age group of 20–29 with a male to female ratio of 10.1:1. The mandible was the most frequently fractured bone in the facial skeleton followed by the zygomatico-maxillary complex. A majority (96%) of patients with head injuries had fractures of either the upper third or the middle third of the face. Contusions and pneumocephalus were the most common head injury encountered. The Glasgow Coma Scale score was significantly lower in patients with associated head injuries as compared to those patients with facial trauma alone. The mortality rate in the study was 2% with both the victims having sustained middle third and upper third fractures respectively with associated head injuries. Conclusion: The facial skeleton does not act to cushion the brain from injury but, in fact, the facial trauma victims should be considered potential head injury patients.