The Association Between Maxillofacial Trauma and Traumatic Brain Injury

The Association Between Maxillofacial Trauma and Traumatic Brain Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article href="https://www.tandfonline.com/doi/full/10.1080/08869634.2024.2425918?src=">The Association Between Maxillofacial Trauma and Traumatic Brain Injury Anwar B Bataineh, Rawand A. Mustafa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6947981/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim The aim of the study was to investigate the incidence of TBI associated with maxillofacial trauma. Methods This is a retrospective review of the medical records of patients with TBI associated with maxillofacial fractures. All injuries were confirmed clinically and radiographically, which included plain radiography, CT scan, and MRI imaging. which included plain radiography, CT scan, and MRI imaging. Patients were included in the study if they had a maxillofacial fracture with associated TBI. Data on age, sex, causes, anatomical site, maxillofacial fractures, and associated injuries were reviewed. Results A total of 68 patients had maxillofacial fractures associated with TBI. Of those, 52 (76.5%) patients were males, and 16 (23.5%) patients were females, with a male/female ratio of 3.25:1. The patients’ ages ranged from 5 to 66 years, with a mean (SD) of 27.1 (12.4) year. The most common sites of the mandible fracture were parasymphysis (n = 14, 26.9%) and angle (n = 14, 26.9%). In maxilla there were dentoalveolar (n = 10, 35.7%) and LeFort I (n = 9, 32.2%) fractures. The skull fractures were frontal bone with 20 (51.3%) fractures, whereas intracranial lesions were concussion (n = 18, 32.8%) followed by cerebral contusion (n = 16, 29.1%). Commonly cranial hematomas were subdural hematoma (n = 12, 21.8%). Conclusion Circumstantial evidence, there is a correlation between the incidence of TBI and maxillofacial trauma that are linked to increase with frontal bone and midfacial fractures. Dentistry Head injury Maxillofacial fracture Craniocerebral injurie Road traffic accident INTRODUCTION Maxillofacial fractures are commonly associated with various concomitant traumatic injuries, such as traumatic brain injury (TBI). TBI is defined as structural damage to the brain caused by external force, in which an alteration in brain function is temporarily, or permanently impaired. The facial skeleton because of the close anatomic proximity of maxillofacial bones can directly or indirectly transmit imparted physical forces to the cranium and frequently result in primary or secondary TBI. A high velocity impacts may result in fracture of facial bones and life threatening intracranial hemorrhages in different compartments. The presence of those fractures has important implications for diagnostic imaging studies, the treatment decisions to repair the facial fractures, and the timing of the surgery [ 1 , 2 , 3 ]. The maxilla and the neighboring facial bones act as a protective cushion for the cranial bones, protecting the brain from a direct impact of any external forces imparted to the head [ 4 ]. The incidence and causes of maxillofacial fractures vary considerably across the globe. The most common causes of maxillofacial fractures are road traffic accidents (RTAs), assaults, sports incidents, falls, and industrial incidents [ 5 ]. As the midface can absorb some of the external forces to the facial skull, it is believed that it might also safeguard the cranium. However, some experts believe such forces propagate directly to the skull base and thus impact the cranium [ 6 ]. Therefore, maxillofacial surgeons must have an extensive understanding of the pathophysiology of head trauma, as it may lead to TBI, thus influencing the diagnosis and treatment [ 7 ]. Patients who have maxillofacial fractures and associated head and neck injuries are more likely to suffer TBI than those who have associated injuries outside of the head and neck area or isolated injury. Research on the pattern of maxillofacial fractures, as well as associated injuries is scarce in Jordan. The structure of this study is a retrospective review. It examines the medical records of patients who suffer from maxillofacial fractures in addition to traumatic brain injury (TBI). To fully understand the relationship between these conditions, the study examines age, sex, fracture patterns, causes, anatomical site, maxillofacial fractures, and associated injuries. We decided to conduct this study due to a shortage of information about Jordanian patients in the literature about the relationship between TBI and maxillofacial trauma, the controversial findings of earlier research, and the high prevalence of TBI with its associated mortality and morbidity. The aim of the study was to investigate the incidence of TBI associated with maxillofacial trauma. MATERIAL AND METHODS This is a retrospective review of the medical records of patients with TBI-associated with maxillofacial fractures who were treated at the Department of Oral Maxillofacial Surgery at King Abdullah University Hospital (KAUH) between 2015 to 2019. KAUH is a tertiary hospital serving a population of 3.2 million situated in the northern part of Jordan. This study has been carried out in accordance with The Code of Ethics of the World Medical Association Helsinki declaration and its later amendments and were in accordance with the ethical standards of the institutional research committee. The Institutional Review Board at the Jordan University of Science and Technology has confirmed that no ethical approval is required due to retrospective nature. All injuries were confirmed clinically and radiographically confirmed, which included plain radiography, CT scan, and MRI imaging. Patients were included in the study if they had a maxillofacial fracture with associated TBI. Patients with incomplete medical records had a history of previous maxillofacial fractures and had an existing pathological disorder involving the face that can cause maxillofacial fractures were excluded. Data on age, sex, causes, anatomical site, maxillofacial fractures, and associated injuries were reviewed. The causes of injury were classified as RTAs, violence, gunshot, falls, sports, and industrial cause. Maxillofacial fractures were classified as mandible, maxilla, and zygoma. Mandibular fractures were further classified as symphysis, parasymphysis, body, angle, ramus, condyle, or dentoalveolar. Maxillary fractures were classified as LeFort I, LeFort II, LeFort III or dentoalveolar and maxillary sinus. The zygoma was classified as zygomatic buttress, zygomatic arch, zygomatomaxillary suture and zygomatofrontal suture. Associated TBI were classified as skull fractures or intracranial lesions. Skull fractures were classified as frontal, parietal, temporal, occipital, ethmoid and sphenoid. The intracranial lesions were classified as concussion, contusion, and intracerebral hematoma including epidural hematoma, subdural hematoma, or subarachnoid hematoma, as confirmed by radiography and included bony fractures. Maxillofacial fractures were treated by the Oral and Maxillofacial Surgery Unit, and TBI were handled by the Neurosurgery Department. Data were analyzed using IBM SPSS version 24. Descriptive data were presented using percentages, a Chi-Square test was performed to compare proportions, the differences were considered significant at p ≤ 0.05. Age group, male-to-female ratio, percentage of traumatic head injuries linked to facial trauma, primary cause of facial trauma, most common type of facial trauma, and most common type of traumatic head injuries were among the data collected using a data collection form created and utilized for each of the included studies. RESULTS A total of 68 patients had maxillofacial fractures associated with TBI. The demographic patient’s data revealed that the distribution of TBI according to the age of the patients ranged from 5 to 66 years, with a mean age of 27.1 (SD) (12.4) years. A total of 20 (29.4%) patients aged 21 − 30 years. The demographic patient’s data revealed that the distribution of TBI according to the age of the patients ranged from 5 to 66 years, with a mean age of 27.1 (SD) (12.4) years. Majority of patients were in the age group of 21–30 years with a total of 20(29.4%) followed by age group of 11–20 with a total of 19(27.9%). The distribution of TBI according to sex showed that 52(76.5%) patients were males, and 16(23.5%) patients were females, with a male/female ratio of 3.25:1. RTAs are the most common cause there were in 45(66.2%) patients, followed by falls 10(14.7%) patients and violence 8(11.8%) patients. Distribution of sex according to age group and etiology is shown in (Table 1 ). Table 1 Distribution of Sex according to Age group and Etiology Age Sex Total % P Value Male Female 50 3 0 3 4.4 Total [%] 52 16 68 100.0 Etiology RTA 31 14 45 66.2 0.357 Violence 8 0 8 11.8 Gunshot 1 0 1 1.5 Falls 8 2 10 14.7 Sports 2 0 2 2.9 Industrial 2 0 2 2.9 Total 52 16 68 100.0 Several patients exhibited involvement of multiple sites within the maxillofacial bone, among all patterns of maxillofacial fractures, mandibular fractures were a total of 52(46.4%) fractures. The most common sites of the mandibular fractures were angle and parasymphysis with 14(26.9%) fractures for each, followed by zygoma fractures with 32(28.6%) fractures. The most common fracture in zygoma fractures were zygomatic arch with 20(62.5%) fractures. While maxillary fractures had 28(25%) fractures and the most common fracture in maxilla was dentoalveolar 10(35.7%) fractures and LeFort I 9(32.2%) fractures. Distribution of Maxillofacial fractures is shown in (Table 2 ). Table 2 Distribution of maxillofacial fractures Facial Bone n % Mandible 52 46.4 Maxilla 28 25.0 Zygoma 32 28.6 Mandible Dentoalveolar 8 15.3 Symphysis 5 9.6 Parasymphysis 14 26.9 Body 8 15.3 Angle 14 26.9 Ramus 2 4.0 Condyle 1 2.0 Total 52 100 Zygoma Zygomatic Buttress 11 34.3 Zygomatic Arch 20 62.5 ZM Suture 0 0.0 ZF Suture 1 3.2 Total 32 100 Maxilla Le Fort 1 9 32.2 Le Fort II 6 21.5 Le Fort III 1 3.5 Dentoalveolar 10 35.7 Maxillary sinus 2 7.1 Total 28 100 The most common cause of injury was RTA accounting for 71(%) followed by a fall 19(%). Regarding the fracture type, mandibular angle and parasymphysis were most fractured 28(54%), maxillary dentoalveolar 10(35.7%) and Lefort I 9(32.1%) and zygomatic arch 20(62.5%) were the anatomical sites most fractured. Distribution of anatomical site of maxillofacial fractures according to etiology is shown in (Table 3 ). Table 3 Distribution of Anatomical site of maxillofacial fractures according to Etiology Site of maxillofacial fractures Etiology Total % P-value RTA Falls Violence Gunshot Industrial Sport Mandible Angel 7 3 2 0 0 2 14 (27) 0.080 Body 4 2 1 1 0 0 8 (15.3) 0.107 Condyle 1 0 0 0 0 0 1 (1.9) 0.991 Mandibular Dentoalveolar 6 1 1 0 0 0 8 (15.3) 0.977 Symphysis 3 2 0 0 0 0 5 (9.7) 0.637 Parasymphysis 10 3 0 0 0 1 14 (27) 0.477 Ramus 2 0 0 0 0 0 2 (3.8) 0.958 Total % 33 (63.4) 11 (21.2) 4 (7.7) 1 (1.9) 0 3 (5.8) 52 (100) Maxilla Le Fort I 4 3 1 0 1 0 9 (32.1) 0.643 Le Fort II 4 1 1 0 0 0 6 (21.4) 0.958 Le Fort III 0 0 1 0 0 0 1 (3.6) 0.179 Maxillary Dentoalveolar 8 0 2 0 0 0 10 (35.7) 0.608 Maxillary Sinus 2 0 0 0 0 0 2 (7.2) 0.958 Total 18 (64.2) 4 (14.3) 5 (17.9) 0 1 (3.6) 0 28 (100) Zygoma Zygomatic arch 13 3 4 0 0 0 20 (62.5) 0.925 Zygomatomaxillary buttress 7 0 2 0 2 0 11 (34.4) 0.020 ZM Suture 0 0 0 0 0 0 0 Zygomatofrontal Suture 0 1 0 0 0 0 1 (3.1) 0.317 Total 20 (62.5) 4 (12.5) 6 (18.8) 0 2 (6.2) 0 32 (100) The most common skull fractures were the frontal bone with 20(51.3%) fractures. Whereas the most common intracranial lesions were concussion with 18(32.8%) patients, followed by cerebral contusion16(29.1%) patients. The most common cranial hematomas were subdural hematoma with 12(21.8%) patients. Distribution of skull bone fractures and types of TBI is shown in (Table 4 ). Table 4 Distribution of Skull bone fractures and types of TBI Skull n % Frontal 20 51.3 Temporal 5 12.8 Occipital 2 5.2 Parietal 1 2.5 Sphenoid 5 12.8 Ethmoid 6 15.4 Total 39 100 Intracranial lesions n % Contusion 16 29.1 Concussion 18 32.8 Epidural hematoma 6 10.9 Subdural hematoma 12 21.8 Subarachnoid hematoma 3 5.4 Total 55 100 DISCUSSION Although the incidence and patterns of maxillofacial fractures associated with TBI have been previously studied in different countries [ 8 , 9 ], the available data is insufficient to establish reliable associations between these phenomena, likely due to the inconsistencies in the case selection criteria and the TBI detection techniques. Cultural and environmental factors contribute to the variations in these associations [ 10 ]. Maas and colleagues reported that TBI were present in 36.7% of the maxillofacial trauma cases included in their analyses [ 11 ]. It has been argued that midface fractures often result in TBI due to the proximity of these regions and the inability of facial bones to withstand strong external forces [ 12 ]. It is also worth noting that the patient cohort characteristics inevitably impact on the reported results, given that certain injury types are more common among different age groups. For example, although patients whose records were analyzed as a part of the present study were aged 5 to 66 years, the mean age of 27.1 years indicates that many were young adults, coinciding with the mean age (31.14 years) reported by other authors [ 1 ]. Indeed, most of the trauma victims were in the 21–30 age group. It is often assumed that people in this age group are more prone to maxillofacial trauma, as they tend to be more involved in riskier outdoor activities [ 13 ]. Studies showed a strong correlation between age and TBI risk [ 14 ]. Still, it is worth noting that 76.5% of the current sample comprised of males, which is equivalent to a male/female ratio of 3.25:1 and agrees with the findings reported by Latifi, whose study sample comprised 72% males and 28% females [ 15 ], while being significantly lower than 10.1:1 reported by Kamath et al. [ 16 ]. According to a further review of pertinent literature, was found 6:1 male to female ratio [ 17 ]. Li et al. indicated that this type of trauma is more likely to affect males than females with 1.74:1 ratio [ 18 ]. As these findings differ considerably, they may indicate cultural disparities between male and female involvement in dangerous sports, reckless driving, and physical altercations [ 19 ]. Concurring with the available data TBI in the present study was primarily caused by RTAs. Other studies [ 20 , 21 ] reported that most patients who present with maxillofacial trauma accompanied by TBI have been involved in RTA, due to the inability of the facial structures to absorb extensive external forces, which therefore propagate to the brain. While some authors reported no significant association between etiology and TBI [ 2 , 22 ], others noted presence of a significant association between etiology and head injury [ 23 , 24 ]. In line with previous reports [ 11 ], the findings revealed that most of the mandible fractures were of parasymphysis and angle type. In addition, maxillary dentoalveolar and LeFort I were most frequently observed maxillary fractures, and zygoma involvement was recorded in 28.57% of fractures. Authors have failed to establish a direct link between the number of fractures and the TBI risk [ 25 ]. Nonetheless, ample body of evidence indicates that more extensive facial bone fractures tend to exacerbate the forces, especially their rotational components, imparted to the cranial vault with the potential to cause TBI. In the cohort examined in the present study, mandible was the most frequently involved bone in the maxillofacial skeleton (46.4%), followed by the zygomaticomaxillary complex (28.57%). Similarly, in their survey involving 402 patients, Haug et al. [ 9 ] observed that 67% suffered mandibular fractures, 21% zygomatic fractures, and 11% maxillary fractures. Oji similarly opined that maxillofacial trauma and TBI frequently involved the mandible because it is the least protected bone in the facial skeleton [ 26 ]. Hung et al. indicated that non-penetrating injuries were more likely to result in midface than mandible fracture [ 27 ]. Still, according to the analyses conducted by Kloss et al., the zygoma and orbit are the most fractured bones in patients that have suffered intracranial hemorrhage following facial fractures but have not lost consciousness [ 28 ]. These differences are noteworthy but are likely due to the variations in injury classification and/or research methodology. The current analyses further revealed that subdural hemorrhage [21.8%] followed by epidural hemorrhage [10.9%] emerged as the most prevalent. However, authors of previous studies reported conflicting findings. Hohlrieder et al. [ 29 ] found that mandibular fracture did not significantly increase the risk of intracranial hemorrhage, which was 2 to 4-fold greater in patients with LeFort II and LeFort III, orbit, nose, zygoma, and maxillary fractures. Conversely, in other studies, 25.5% of the patients had skull fractures, the majority of which involved the frontal bone [ 8 ]. Higher incidences of TBI are associated with frontal bone with 20(17.85%) and mid-facial fractures include maxilla and zygoma were in 60(53.57%). This finding is expected, as the frontal bone is in direct anatomic contact with the maxillofacial bones and is thus more likely to fracture compared to other skull bones. It also coincides with the 34.82% of skull fractures prevalence noted in the current study sample. Hence, intracranial hemorrhage should be suspected in patients that have suffered maxillofacial fractures even if they have normal neurological findings and have not lost consciousness [ 14 ]. The incidence and etiology of TBI depend on the maxillofacial trauma reflects community trauma patterns and can serve as a guide for creating preventative and management initiatives. The two main causes of TBI are still road traffic accidents. Therefore, strategies to reduce the incidence of TBI are crucial to inform the public of associated morbidity and the value of preventative interventions. Implementing laws to increase the criminal liability of the aggressor as well as educating the populace about the use of protective devices, strict laws and severe punishments for violators are among the strategies that must be used to reduce the incidence of craniocerebral injuries. Other strategies include proper road traffic regulations, strict legislative measures regarding use of the seat belt, wearing of the helmet, restricted speed limits, and unwavering adherence to traffic rules. CONCLUSION Most patients were between the ages of 21 and 30. The most frequent causes are RTAs, falls, and violence. The most frequent fractures were mandibular fractures with sites of angle and parasymphysis fractures. Zygomatic arch fractures were the most frequent type of zygoma fracture. On the other hand, LeFort and dentoalveolar fractures were the most frequent in the maxilla. The frontal bone of the skull was most frequently fractured, and concussions and cerebral contusions were the most frequent intracranial lesions. Subdural hematomas were the most prevalent type of cranial hematoma. TBI is associated with maxillofacial trauma, and frontal bone and midfacial fractures are associated with a higher incidence of TBI, according to circumstantial evidence. The incidence of death and morbidity is decreased when such accidents are referred early to a medical facility with the necessary resources. Declarations Funding: This research received no external funding. Acknowledgments: The author wishes to thank Jordan University of Science and Technology and Tishk International University for the administrative or technical support. Institutional Review Board Statement: The Institutional Review Board at the Jordan University of Science and Technology were waived for this study due to retrospective nature. Not applicable Informed Consent Statement: Not applicable. Ethical approval: Due to the retrospective nature of this study, it was granted an exemption. Data availability statement: Data available on request from the corresponding author. Author’s Contributors: Concept and design of study or acquisition of data (Anwar B. Bataineh) or analysis and interpretation of data (Rawand A. Mustafa). Final approval of the version to be published (Anwar B. Bataineh), (Rawand A. Mustafa). Conflicts of interest: The authors declares that there is no conflict of interest. References Lim LH, Lam LK, Moore MH, Trott JA, David DJ (1993) Associated injuries in facial fractures: review of 839 patients. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6947981","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":474613084,"identity":"a2369498-546a-442d-9e16-7fa520a715c7","order_by":0,"name":"Anwar B Bataineh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYPCCA0DM2ABENgxsID4PGBHQwgPRkiZBihawRYclGKBacAL+2T2GnysY7sjbsx9ue/Bxx/k6PokExgdv2xhk+A5g1yJx54yx5BmGZ4Y9PInthjPP3JZgk0hgNpzbxsAjiUMLw43cDZINDIcZexgS26R528Ba2IAMBh4DHFrkb+Ru/gnUYt/D/7BN+m/bOZAW9t/4tBjcyN0GsiWxRwJoC2PbAbAtzPi0GN7I/2bZYPAsuefGwzbJ3rZkyTaeh82Sc85J4PSL3I205JsNFXds2/vTn0n8bLPjl29PPvjhTZmNPa4QgzoPhQeMU2BQQpIEiYAMLaNgFIyCUTAsAQALw1pIi9lgpwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-2787-0180","institution":"Tishk International University","correspondingAuthor":true,"prefix":"","firstName":"Anwar","middleName":"B","lastName":"Bataineh","suffix":""},{"id":474613085,"identity":"2a67a2cc-5243-4f30-993c-db5e8960006b","order_by":1,"name":"Rawand A. Mustafa","email":"","orcid":"","institution":"Tishk International University","correspondingAuthor":false,"prefix":"","firstName":"Rawand","middleName":"A.","lastName":"Mustafa","suffix":""}],"badges":[],"createdAt":"2025-06-22 06:29:01","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6947981/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6947981/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85264090,"identity":"07fa79a6-9332-4f0a-88b2-3a3ae43cac46","added_by":"auto","created_at":"2025-06-24 04:47:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":898436,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6947981/v1/d900f98c-52e6-47b7-80c1-2411f067910c.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003ca href=\"https://www.tandfonline.com/doi/full/10.1080/08869634.2024.2425918?src=\"\u003e\u003cstrong\u003eThe Association Between\u003c/strong\u003e\u003c/a\u003e\u003cstrong\u003e Maxillofacial Trauma and Traumatic Brain Injury\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMaxillofacial fractures are commonly associated with various concomitant traumatic injuries, such as traumatic brain injury (TBI). TBI is defined as structural damage to the brain caused by external force, in which an alteration in brain function is temporarily, or permanently impaired. The facial skeleton because of the close anatomic proximity of maxillofacial bones can directly or indirectly transmit imparted physical forces to the cranium and frequently result in primary or secondary TBI. A high velocity impacts may result in fracture of facial bones and life threatening intracranial hemorrhages in different compartments. The presence of those fractures has important implications for diagnostic imaging studies, the treatment decisions to repair the facial fractures, and the timing of the surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The maxilla and the neighboring facial bones act as a protective cushion for the cranial bones, protecting the brain from a direct impact of any external forces imparted to the head [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence and causes of maxillofacial fractures vary considerably across the globe. The most common causes of maxillofacial fractures are road traffic accidents (RTAs), assaults, sports incidents, falls, and industrial incidents [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As the midface can absorb some of the external forces to the facial skull, it is believed that it might also safeguard the cranium. However, some experts believe such forces propagate directly to the skull base and thus impact the cranium [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, maxillofacial surgeons must have an extensive understanding of the pathophysiology of head trauma, as it may lead to TBI, thus influencing the diagnosis and treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients who have maxillofacial fractures and associated head and neck injuries are more likely to suffer TBI than those who have associated injuries outside of the head and neck area or isolated injury. Research on the pattern of maxillofacial fractures, as well as associated injuries\u003c/p\u003e \u003cp\u003eis scarce in Jordan. The structure of this study is a retrospective review. It examines the medical records of patients who suffer from maxillofacial fractures in addition to traumatic brain injury (TBI). To fully understand the relationship between these conditions, the study examines age, sex, fracture patterns, causes, anatomical site, maxillofacial fractures, and associated injuries. We decided to conduct this study due to a shortage of information about Jordanian patients in the literature about the relationship between TBI and maxillofacial trauma, the controversial findings of earlier research, and the high prevalence of TBI with its associated mortality and morbidity. The aim of the study was to investigate the incidence of TBI associated with maxillofacial trauma.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003e This is a retrospective review of the medical records of patients with TBI-associated with maxillofacial fractures who were treated at the Department of Oral Maxillofacial Surgery at King Abdullah University Hospital (KAUH) between 2015 to 2019. KAUH is a tertiary hospital serving a population of 3.2\u0026nbsp;million situated in the northern part of Jordan. This study has been carried out in accordance with The Code of Ethics of the World Medical Association Helsinki declaration and its later amendments and were in accordance with the ethical standards of the institutional research committee. The Institutional Review Board at the Jordan University of Science and Technology has confirmed that no ethical approval is required due to retrospective nature.\u003c/p\u003e \u003cp\u003eAll injuries were confirmed clinically and radiographically confirmed, which included plain radiography, CT scan, and MRI imaging. Patients were included in the study if they had a maxillofacial fracture with associated TBI. Patients with incomplete medical records had a history of previous maxillofacial fractures and had an existing pathological disorder involving the face that can cause maxillofacial fractures were excluded.\u003c/p\u003e \u003cp\u003eData on age, sex, causes, anatomical site, maxillofacial fractures, and associated injuries were reviewed. The causes of injury were classified as RTAs, violence, gunshot, falls, sports, and industrial cause. Maxillofacial fractures were classified as mandible, maxilla, and zygoma. Mandibular fractures were further classified as symphysis, parasymphysis, body, angle, ramus, condyle, or dentoalveolar. Maxillary fractures were classified as LeFort I, LeFort II, LeFort III or dentoalveolar and maxillary sinus. The zygoma was classified as zygomatic buttress, zygomatic arch, zygomatomaxillary suture and zygomatofrontal suture. Associated TBI were classified as skull fractures or intracranial lesions. Skull fractures were classified as frontal, parietal, temporal, occipital, ethmoid and sphenoid. The intracranial lesions were classified as concussion, contusion, and intracerebral hematoma including epidural hematoma, subdural hematoma, or subarachnoid hematoma, as confirmed by radiography and included bony fractures. Maxillofacial fractures were treated by the Oral and Maxillofacial Surgery Unit, and TBI were handled by the Neurosurgery Department.\u003c/p\u003e \u003cp\u003eData were analyzed using IBM SPSS version 24. Descriptive data were presented using percentages, a Chi-Square test was performed to compare proportions, the differences were considered significant at p\u0026thinsp;\u0026le;\u0026thinsp;0.05. Age group, male-to-female ratio, percentage of traumatic head injuries linked to facial trauma, primary cause of facial trauma, most common type of facial trauma, and most common type of traumatic head injuries were among the data collected using a data collection form created and utilized for each of the included studies.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 68 patients had maxillofacial fractures associated with TBI. The demographic patient\u0026rsquo;s data revealed that the distribution of TBI according to the age of the patients ranged from 5 to 66 years, with a mean age of 27.1 (SD) (12.4) years. A total of 20 (29.4%) patients aged 21\u0026thinsp;\u0026minus;\u0026thinsp;30 years. The demographic patient\u0026rsquo;s data revealed that the distribution of TBI according to the age of the patients ranged from 5 to 66 years, with a mean age of 27.1 (SD) (12.4) years. Majority of patients were in the age group of 21\u0026ndash;30 years with a total of 20(29.4%) followed by age group of 11\u0026ndash;20 with a total of 19(27.9%).\u003c/p\u003e \u003cp\u003eThe distribution of TBI according to sex showed that 52(76.5%) patients were males, and 16(23.5%) patients were females, with a male/female ratio of 3.25:1. RTAs are the most common cause there were in 45(66.2%) patients, followed by falls 10(14.7%) patients and violence 8(11.8%) patients. Distribution of sex according to age group and etiology is shown in (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Sex according to Age group and Etiology\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003e0.655\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e 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\u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGunshot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndustrial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e52\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSeveral patients exhibited involvement of multiple sites within the maxillofacial bone, among all patterns of maxillofacial fractures, mandibular fractures were a total of 52(46.4%) fractures. The most common sites of the mandibular fractures were angle and parasymphysis with 14(26.9%) fractures for each, followed by zygoma fractures with 32(28.6%) fractures. The most common fracture in zygoma fractures were zygomatic arch with 20(62.5%) fractures. While maxillary fractures had 28(25%) fractures and the most common fracture in maxilla was dentoalveolar 10(35.7%) fractures and LeFort I 9(32.2%) fractures. Distribution of Maxillofacial fractures is shown in (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of maxillofacial fractures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacial Bone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMandible\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentoalveolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymphysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParasymphysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRamus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e52\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eZygoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygomatic Buttress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygomatic Arch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZM Suture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZF Suture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaxilla\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLe Fort 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLe Fort II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLe Fort III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentoalveolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillary sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most common cause of injury was RTA accounting for 71(%) followed by a fall 19(%). Regarding the fracture type, mandibular angle and parasymphysis were most fractured 28(54%), maxillary dentoalveolar 10(35.7%) and Lefort I 9(32.1%) and zygomatic arch 20(62.5%) were the anatomical sites most fractured. Distribution of anatomical site of maxillofacial fractures according to etiology is shown in (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Anatomical site of maxillofacial fractures according to Etiology\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSite of maxillofacial fractures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRTA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFalls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eViolence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGunshot\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndustrial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSport\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e14 (27)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.080\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e8 (15.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.107\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1 (1.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.991\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandibular Dentoalveolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e8 (15.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.977\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymphysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e5 (9.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.637\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParasymphysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e14 (27)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.477\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRamus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e2 (3.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.958\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal %\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e33 (63.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e11 (21.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4 (7.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1 (1.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3 (5.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e52 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaxilla\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLe Fort I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e9 (32.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.643\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLe Fort II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e6 (21.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.958\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLe Fort III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1 (3.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.179\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillary Dentoalveolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e10 (35.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.608\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxillary Sinus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e2 (7.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.958\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e18 (64.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4 (14.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e5 (17.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1 (3.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e28 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eZygoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygomatic arch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e20 (62.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.925\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygomatomaxillary buttress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e11 (34.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZM Suture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZygomatofrontal Suture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e1 (3.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.317\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20 (62.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4 (12.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6 (18.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2 (6.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e32 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most common skull fractures were the frontal bone with 20(51.3%) fractures. Whereas the most common intracranial lesions were concussion with 18(32.8%) patients, followed by cerebral contusion16(29.1%) patients. The most common cranial hematomas were subdural hematoma with 12(21.8%) patients. Distribution of skull bone fractures and types of TBI is shown in (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of Skull bone fractures and types of TBI\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSkull\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrontal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccipital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParietal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSphenoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthmoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e39\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntracranial lesions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" class=\"fr-cell-handler \"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" class=\"fr-cell-fixed \"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcussion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEpidural hematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubdural hematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubarachnoid hematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e55\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAlthough the incidence and patterns of maxillofacial fractures associated with TBI have been previously studied in different countries [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the available data is insufficient to establish reliable associations between these phenomena, likely due to the inconsistencies in the case selection criteria and the TBI detection techniques. Cultural and environmental factors contribute to the variations in these associations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Maas and colleagues reported that TBI were present in 36.7% of the maxillofacial trauma cases included in their analyses [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It has been argued that midface fractures often result in TBI due to the proximity of these regions and the inability of facial bones to withstand strong external forces [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is also worth noting that the patient cohort characteristics inevitably impact on the reported results, given that certain injury types are more common among different age groups. For example, although patients whose records were analyzed as a part of the present study were aged 5 to 66 years, the mean age of 27.1 years indicates that many were young adults, coinciding with the mean age (31.14 years) reported by other authors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Indeed, most of the trauma victims were in the 21–30 age group. It is often assumed that people in this age group are more prone to maxillofacial trauma, as they tend to be more involved in riskier outdoor activities [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Studies showed a strong correlation between age and TBI risk [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Still, it is worth noting that 76.5% of the current sample comprised of males, which is equivalent to a male/female ratio of 3.25:1 and agrees with the findings reported by Latifi, whose study sample comprised 72% males and 28% females [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while being significantly lower than 10.1:1 reported by Kamath et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. According to a further review of pertinent literature, was found 6:1 male to female ratio [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Li et al. indicated that this type of trauma is more likely to affect males than females with 1.74:1 ratio [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. As these findings differ considerably, they may indicate cultural disparities between male and female involvement in dangerous sports, reckless driving, and physical altercations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConcurring with the available data TBI in the present study was primarily caused by RTAs. Other studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] reported that most patients who present with maxillofacial trauma accompanied by TBI have been involved in RTA, due to the inability of the facial structures to absorb extensive external forces, which therefore propagate to the brain. While some authors reported no significant association between etiology and TBI [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], others noted presence of a significant association between etiology and head injury [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn line with previous reports [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], the findings revealed that most of the mandible fractures were of parasymphysis and angle type. In addition, maxillary dentoalveolar and LeFort I were most frequently observed maxillary fractures, and zygoma involvement was recorded in 28.57% of fractures. Authors have failed to establish a direct link between the number of fractures and the TBI risk [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Nonetheless, ample body of evidence indicates that more extensive facial bone fractures tend to exacerbate the forces, especially their rotational components, imparted to the cranial vault with the potential to cause TBI. In the cohort examined in the present study, mandible was the most frequently involved bone in the maxillofacial skeleton (46.4%), followed by the zygomaticomaxillary complex (28.57%). Similarly, in their survey involving 402 patients, Haug et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] observed that 67% suffered mandibular fractures, 21% zygomatic fractures, and 11% maxillary fractures. Oji similarly opined that maxillofacial trauma and TBI frequently involved the mandible because it is the least protected bone in the facial skeleton [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Hung et al. indicated that non-penetrating injuries were more likely to result in midface than mandible fracture [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Still, according to the analyses conducted by Kloss et al., the zygoma and orbit are the most fractured bones in patients that have suffered intracranial hemorrhage following facial fractures but have not lost consciousness [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These differences are noteworthy but are likely due to the variations in injury classification and/or research methodology.\u003c/p\u003e \u003cp\u003eThe current analyses further revealed that subdural hemorrhage [21.8%] followed by epidural hemorrhage [10.9%] emerged as the most prevalent. However, authors of previous studies reported conflicting findings. Hohlrieder et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] found that mandibular fracture did not significantly increase the risk of intracranial hemorrhage, which was 2 to 4-fold greater in patients with LeFort II and LeFort III, orbit, nose, zygoma, and maxillary fractures. Conversely, in other studies, 25.5% of the patients had skull fractures, the majority of which involved the frontal bone [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Higher incidences of TBI are associated with frontal bone with 20(17.85%) and mid-facial fractures include maxilla and zygoma were in 60(53.57%). This finding is expected, as the frontal bone is in direct anatomic contact with the maxillofacial bones and is thus more likely to fracture compared to other skull bones. It also coincides with the 34.82% of skull fractures prevalence noted in the current study sample.\u003c/p\u003e \u003cp\u003eHence, intracranial hemorrhage should be suspected in patients that have suffered maxillofacial fractures even if they have normal neurological findings and have not lost consciousness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence and etiology of TBI depend on the maxillofacial trauma reflects community trauma patterns and can serve as a guide for creating preventative and management initiatives. The two main causes of TBI are still road traffic accidents. Therefore, strategies to reduce the incidence of TBI are crucial to inform the public of associated morbidity and the value of preventative interventions. Implementing laws to increase the criminal liability of the aggressor as well as educating the populace about the use of protective devices, strict laws and severe punishments for violators are among the strategies that must be used to reduce the incidence of craniocerebral injuries. Other strategies include proper road traffic regulations, strict legislative measures regarding use of the seat belt, wearing of the helmet, restricted speed limits, and unwavering adherence to traffic rules.\u003c/p\u003e "},{"header":"CONCLUSION","content":"\u003cp\u003eMost patients were between the ages of 21 and 30. The most frequent causes are RTAs, falls, and violence. The most frequent fractures were mandibular fractures with sites of angle and parasymphysis fractures. Zygomatic arch fractures were the most frequent type of zygoma fracture. On the other hand, LeFort and dentoalveolar fractures were the most frequent in the maxilla.\u003c/p\u003e\u003cp\u003eThe frontal bone of the skull was most frequently fractured, and concussions and cerebral contusions were the most frequent intracranial lesions. Subdural hematomas were the most prevalent type of cranial hematoma. TBI is associated with maxillofacial trauma, and frontal bone and midfacial fractures are associated with a higher incidence of TBI, according to circumstantial evidence. The incidence of death and morbidity is decreased when such accidents are referred early to a medical facility with the necessary resources.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The author wishes to thank Jordan University of Science and Technology and Tishk International University for the\u0026nbsp;administrative or technical support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u003c/strong\u003e The Institutional Review Board at the Jordan University of Science and Technology were waived for this study due to retrospective nature.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e Due to the retrospective nature of this study, it was granted an exemption.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eData available on request\u0026nbsp;from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contributors:\u003c/strong\u003e Concept and design of study or acquisition of data (Anwar B. Bataineh) or analysis and interpretation of data (Rawand A. Mustafa).\u0026nbsp;Final approval of the version to be published\u0026nbsp;(Anwar B. Bataineh), (Rawand A. Mustafa).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of\u003c/strong\u003e \u003cstrong\u003einterest:\u003c/strong\u003e The authors declares that there is no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLim LH, Lam LK, Moore MH, Trott JA, David DJ (1993) Associated injuries in facial fractures: review of 839 patients. 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Int J Oral Maxillofac Surg 33(4):389\u0026ndash;395. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijom.2003.10.011\u003c/span\u003e\u003cspan address=\"10.1016/j.ijom.2003.10.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Tishk International University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Head injury, Maxillofacial fracture, Craniocerebral injurie, Road traffic accident","lastPublishedDoi":"10.21203/rs.3.rs-6947981/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6947981/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe aim of the study was to investigate the incidence of TBI associated with maxillofacial trauma.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a retrospective review of the medical records of patients with TBI associated with maxillofacial fractures. All injuries were confirmed clinically and radiographically, which included plain radiography, CT scan, and MRI imaging. which included plain radiography, CT scan, and MRI imaging. Patients were included in the study if they had a maxillofacial fracture with associated TBI. Data on age, sex, causes, anatomical site, maxillofacial fractures, and associated injuries were reviewed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 68 patients had maxillofacial fractures associated with TBI. Of those, 52 (76.5%) patients were males, and 16 (23.5%) patients were females, with a male/female ratio of 3.25:1. The patients\u0026rsquo; ages ranged from 5 to 66 years, with a mean (SD) of 27.1 (12.4) year. The most common sites of the mandible fracture were parasymphysis (n\u0026thinsp;=\u0026thinsp;14, 26.9%) and angle (n\u0026thinsp;=\u0026thinsp;14, 26.9%). In maxilla there were dentoalveolar (n\u0026thinsp;=\u0026thinsp;10, 35.7%) and LeFort I (n\u0026thinsp;=\u0026thinsp;9, 32.2%) fractures. The skull fractures were frontal bone with 20 (51.3%) fractures, whereas intracranial lesions were concussion (n\u0026thinsp;=\u0026thinsp;18, 32.8%) followed by cerebral contusion (n\u0026thinsp;=\u0026thinsp;16, 29.1%). Commonly cranial hematomas were subdural hematoma (n\u0026thinsp;=\u0026thinsp;12, 21.8%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCircumstantial evidence, there is a correlation between the incidence of TBI and maxillofacial trauma that are linked to increase with frontal bone and midfacial fractures.\u003c/p\u003e","manuscriptTitle":"The Association Between Maxillofacial Trauma and Traumatic Brain Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-24 04:30:54","doi":"10.21203/rs.3.rs-6947981/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4186ba4-3367-4f99-9ff7-b5efab8e64da","owner":[],"postedDate":"June 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50398494,"name":"Dentistry"}],"tags":[],"updatedAt":"2025-06-24T04:30:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-24 04:30:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6947981","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6947981","identity":"rs-6947981","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}