Int. J. Oral Maxillofac. Surg. 1995; 24:26-29 Printed in Denmark. All rights reserved Copyright 9 Munksgaard 1995 International Journal of Ord & Max ofacid Surgery ISSN 0901-5027 Cervical spine injuries in patients with facial fractures: a 1-year prospective study J. C. Belrne, R E. Butler, F.A. Brady Departments of Maxillofacial and Plastic Surgery, St James's Hospital, Dublin 8, Ireland J. C. Beirne, P. E. Butler, F. A. Brady: Cervical spine injuries in patients with facial fractures: a 1-year prospective study. Int. J. Oral Maxillofac. Surg. 1995; 24: 26-29. 9 Munksgaard, 1995 Abstract. A total Of 582 consecutive patients with facial fractures were investi- gated prospectively for evidence of a concomitant cervical spine injury. Of them, 1.04% (6) were found to have a cervical spine injury, all having occurred in road traffic accidents. Only two of the injuries were diagnosable on standard, three-view, plain cervical spine radiographs. Four were diagnosable from computerized tomography scan, while the remaining two required stress views under radio- graphic screening for definitive diagnosis. Key words: cervical spine injury; trauma; facial fracture. Accepted for publication 10 August 1994 It is accepted that there is an incidence of cervical spine injury in the presence of facial fractures of 1.3-4~ 8'16'2~ . However, when the facial fractures examined are confined to those sus- tained in road traffic accidents (RTA), the figures for concomitant cervical spine injury rise to 5.5% 8 . There have also been reports of cervical spine in- juries being diagnosed after definitive maxillofacial surgery9,1~ The cost of maintenance with spinal cord injury may exceed $1 million throughout a patient's life span 11. De- spite recent advances in diagnostic im- aging methods, there may still be a de- lay in establishing a diagnosis3,24 in 10- 25% of patients with facial fractures who have sustained a cervical spine in- jury. The Irish National Maxillofacial Unit in St James's Hospital serves a population of 1.75 million people, tak- ing referrals from 21 general hospitals. A recent study has shown that while as- sault has replaced RTA as the single biggest cause of facial fracture in our practice, RTA still causes a significant percentage of facial fractures 5. With this information in mind, it was decided to conduct a prospective study of the incidence of cervical spine injury in our patient population. Material and methods A prospective 1-year study from 1 January to 31 December 1992 was conducted at the National Maxillofacial Unit, St James's Hos- pital, Dublin, Ireland, of 582 consecutively referred patients with facial fractures. A standard form was designed to record patients' age, sex, occupation, type of facial injury sustained, and cause of the fracture (Table 1). On history and examination, it was noted whether the patient complained of neck pain with or without neurologic symp- toms and whether there was a head injury with associated loss of consciousness. If the cause of the injury was RTA, the seated posi- Table 1. Causes of facial fractures Cause n Percentage Assault 256 43.9 Sport 172 29.7 Road traffic accident 94 16.1 Other 60 10.3 Total 582 100 tion of the patient in the vehicle, whether a seat belt had been worn, and whether the pa- tient had been thrown from the vehicle, were noted. In particular, on examination, the pres- ence of head and neck hard- and soft-tissue injuries was noted and also whether there was cervical spine tenderness or muscle spasm. A neurologic examination was under- taken, and it was noted whether cervical spine collar support was provided. The plain cervical spine radiographs were analysed for adequacy, detail, and complete- ness and the presence of any cervical spine lesion. The cause of any delay in diagnosing a cervical injury was recorded. If indicated, any further or supplementary radiographic examinations (plain radiographs, computer- ized tomography (CT), magnetic resonance imaging (MRI), or stress views) needed to di- agnose an injury were done. Results Six of the 582 patients in the study had cervical spine injury associated with their facial fractures. This represented 1.04% of the patients referred. All pa- tients who sustained a cervical injury had been involved in an RTA. This re- suited in an incidence of cervical spine