Impact of Delayed Surgical Intervention on Functional and Aesthetic Outcomes in Panfacial Fractures: A Retrospective Cohort Study of 120 Patients in a Resource-Limited Tertiary Care Center in Western Rajasthan

Associated Head Injury in Maxillofacial Fractures: A Retrospective Analysis Comparing Panfacial and Isolated Facial Bone Fractures" | 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 Associated Head Injury in Maxillofacial Fractures: A Retrospective Analysis Comparing Panfacial and Isolated Facial Bone Fractures" Dr Chandrashekhar Chattopadhyay, Dr Vikas Deo, Dr Charu Chouhan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7326828/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background : Maxillofacial fractures are common in trauma settings, often associated with head injuries due to the proximity of facial bones to the cranium. This study investigates whether patients with pan facial fractures (involving multiple facial subunits) have a lower incidence of head injuries compared to those with isolated facial bone fractures. Methods : A retrospective analysis was conducted on 650 trauma patients (95% male, aged ≥16 years) treated at a tertiary care centre in Western Rajasthan from July 2023 to June 2025. Patients with limb or chest injuries were excluded. Data on demographics, fracture type, head injury, and aetiology (predominantly road traffic accidents [RTAs] involving two-wheelers) were collected. The Facial Injury Severity Scale (FISS) was used to classify fracture severity. Statistical analysis included chi-square tests and logistic regression (p<0.05). Results : Of 650 patients, 180 (27.7%) had pan facial fractures, and 470 (72.3%) had isolated facial bone fractures. Head injuries were observed in 20% of pan facial fracture cases (36/180) versus 35% of isolated fracture cases (165/470) (p=0.002). RTAs, primarily involving two-wheelers, accounted for 75% of cases. Conclusion : Patients with pan facial fractures have a significantly lower incidence of head injuries compared to those with isolated facial bone fractures, possibly due to the energy-dissipating effect of multiple facial fractures. Dentistry Maxillofacial fractures Pan facial fractures Isolated facial fractures Head injury Road traffic accidents Two-wheelers Introduction Maxillofacial fractures are a significant component of trauma cases, frequently caused by high-energy impacts such as road traffic accidents (RTAs) [ 1 ]. The facial skeleton, comprising the frontal, upper midface, lower midface, and mandibular subunits, lies in close proximity to the cranium, making traumatic brain injury (TBI) a common associated condition [ 2 , 3 ]. Panfacial fractures, defined as fractures involving at least three of the four facial subunits, are complex injuries typically resulting from high-velocity trauma [ 4 , 5 ]. In contrast, isolated facial bone fractures affect a single subunit, such as the mandible or zygoma [ 6 ]. Prior studies suggest that the facial skeleton may act as an energy-absorbing cushion, potentially reducing the risk of TBI in complex fractures [ 7 , 8 ]. In India, particularly in Western Rajasthan, two-wheeler RTAs are a major contributor to maxillofacial trauma, exacerbated by high rates of helmet non-compliance [ 9 , 10 ]. This study aims to compare the incidence of head injuries in patients with panfacial versus isolated facial bone fractures at a tertiary care centre in Western Rajasthan, where two-wheeler RTAs are a leading cause of trauma [ 11 , 12 ]. Materials and Methods Study Design A retrospective cohort study was conducted at the Trauma Centre of a tertiary care hospital in Western Rajasthan. Medical records of patients treated for maxillofacial fractures between July 2023 and June 2025 were reviewed [13]. Inclusion and Exclusion Criteria Inclusion Criteria: Patients aged ≥16 years with maxillofacial fractures (panfacial or isolated). Diagnosed via clinical examination and computed tomography (CT) scans [14]. Treated at the tertiary care centre. Exclusion Criteria: Patients <16 years. Patients with associated limb or chest injuries [15]. Incomplete medical records or isolated soft tissue injuries. Data Collection Data were extracted from 650 patient records, including: Demographics: Age, gender (95% male). Aetiology: Cause of trauma, with a focus on RTAs involving two-wheelers [16]. Fracture Type: Classified as panfacial (fractures in ≥3 facial subunits: frontal, upper midface, lower midface, mandible) or isolated (single subunit fracture) [17]. Head Injury: Diagnosed via CT scans, classified as traumatic brain injury (TBI), including cerebral contusion, haemorrhage, or concussion [18]. Facial Injury Severity Scale (FISS): Used to quantify fracture severity (mild: 1-3, moderate: 4-7, severe: ≥8) [19]. Statistical Analysis Data were analysed using IBM SPSS Statistics version 22.0. Descriptive statistics summarised demographics and fracture patterns. Chi-square tests compared head injury incidence between panfacial and isolated fracture groups. Logistic regression assessed the association between fracture type and head injury, adjusting for age and aetiology [20]. A p-value <0.05 was considered statistically significant. Ethical Considerations Informed consent was obtained at admission for research use. This is a retrospective study based on anonymised patient data only Results Demographics and Aetiology Of 650 patients, 617 (95%) were male, with a mean age of 28.5 ± 7.2 years (range: 16–65 years). Two-wheeler RTAs were the primary aetiology (75%, n=488), followed by interpersonal violence (15%, n=98), falls (8%, n=52), and other causes (2%, n=12) [9]. Among RTA cases, 80% (n=390) involved two-wheelers, with 60% of these patients not using helmets [10]. Fracture Distribution Panfacial Fractures: 180 patients (27.7%), with common sites including maxillary sinus wall (85%, n=153), mandible (80%, n=144), and zygomatic arch (70%, n=126) [17]. Isolated Fractures: 470 patients (72.3%), with mandible (40%, n=188), zygoma (30%, n=141), and nasal bones (20%, n=94) most affected [6]. FISS Scores: Panfacial fractures had a mean FISS score of 10.2 ± 2.1 (severe category), while isolated fractures averaged 3.8 ± 1.5 (mild to moderate category) (p<0.001) [19]. Head Injury Incidence Head injuries, diagnosed as traumatic brain injury (TBI) via CT scans, occurred in 201 patients (30.9%) [18]. The incidence was significantly lower in the panfacial fracture group (20%, n=36/180) compared to the isolated fracture group (35%, n=165/470) (chi-square test, p=0.002) [7]. Common head injuries included cerebral contusion (45%, n=90), subdural hematoma (30%, n=60), and concussion (20%, n=40) [3]. Table 1: Head Injury Incidence by Fracture Type Fracture Type Total Patients No Head Injury (n, %) Head Injury (n, %) Panfacial 180 144 (80%) 36 (20%) Isolated 470 305 (65%) 165 (35%) Caption : Head injury incidence by fracture type, showing lower incidence in panfacial fractures (20%) compared to isolated fractures (35%). Statistical Analysis Logistic regression, adjusted for age and aetiology, confirmed that panfacial fractures were associated with a lower odds ratio of head injury (OR=0.47, 95% CI: 0.31–0.72, p=0.001) [20]. Two-wheeler RTAs were a significant risk factor for head injury (OR=1.82, 95% CI: 1.25–2.65, p=0.003) [11]. Table 2: Aetiology Distribution of Maxillofacial Fractures Aetiology Number of Patients (n) Percentage (%) Two-wheeler RTAs 488 75% Interpersonal Violence 98 15% Falls 52 8% Others 12 2% Caption : Aetiology distribution of maxillofacial fractures, with two-wheeler RTAs as the leading cause (75%). Discussion The key finding of this study is that patients with panfacial fractures exhibit a significantly lower incidence of head injuries (20%) compared to those with isolated facial bone fractures (35%) (p = 0.002) [ 7 ]. This supports the hypothesis that the facial skeleton acts as a protective barrier, absorbing and dissipating traumatic energy before it reaches the cranium [ 2 , 8 ]. Biomechanical studies suggest that the complex structure of the facial bones, including the maxillary sinuses and multiple articulations, functions as a "crumple zone," distributing impact forces across a broader area [ 3 , 4 ]. In panfacial fractures, involving multiple facial subunits (e.g., maxillary sinus wall, mandible, zygomatic arch), the cumulative fracture patterns may absorb a greater proportion of traumatic energy, reducing the force transmitted to the brain [ 5 , 7 ]. In contrast, isolated fractures, such as those of the mandible or zygoma, involve less bone surface area, allowing more energy to be transferred to the cranium, increasing the likelihood of traumatic brain injury (TBI) [ 6 , 8 ]. This finding aligns with Keenan et al. [ 7 ], who reported that facial fractures, particularly complex ones, are associated with a lower incidence of TBI (odds ratio 0.65) compared to cases without facial involvement. Lee et al. [ 2 ] similarly demonstrated that facial fractures reduce the severity of closed head injuries, likely due to energy dissipation. However, Martin et al. [ 8 ] suggest that facial fractures may indicate severe head injury in high-energy trauma, highlighting the need for context-specific analysis. The current study’s focus on panfacial versus isolated fractures and the exclusion of patients with limb or chest injuries may explain these differences, as associated injuries could confound the relationship between facial fractures and head injury [ 15 ]. The high prevalence of two-wheeler RTAs (75%), as shown in Table 2 , reflects the regional epidemiology of trauma in Western Rajasthan, where motorcycles are a dominant mode of transportation [ 9 , 11 ]. The finding that 60% of two-wheeler RTA patients were not wearing helmets underscores a critical public health issue [ 10 ]. Helmet non-compliance increases the risk of both maxillofacial and head injuries, as helmets reduce TBI incidence by up to 40% [ 12 ]. The severe FISS scores in panfacial fractures (mean 10.2, severe category) compared to isolated fractures (mean 3.8, mild to moderate category) indicate higher trauma energy in the former group, yet the lower head injury rate suggests that the complexity of panfacial fractures mitigates cranial impact [ 19 ]. This paradox may be explained by the biomechanical properties of the facial skeleton, where multiple fracture lines create a network of energy absorption, reducing force transmission to the neurocranium [ 4 , 17 ]. Clinically, these findings have significant implications for trauma management. Patients with isolated facial fractures require prioritised neurological evaluation due to their higher head injury risk (35%) [ 7 , 18 ]. Conversely, while panfacial fractures demand complex surgical reconstruction, their lower association with head injuries may allow clinicians to focus on facial repair after ruling out life-threatening intracranial injuries [ 5 ]. The predominance of two-wheeler RTAs highlights the urgent need for public health interventions, such as mandatory helmet laws and road safety campaigns, particularly in semi-urban and rural Western Rajasthan [ 9 , 16 ]. Educational programmes targeting young male riders, who constitute 95% of this cohort, could reduce maxillofacial trauma burden [ 12 ]. Limitations include the retrospective design, which introduces potential selection bias due to exclusion of patients with incomplete records or lost to follow-up [ 13 ]. Reliance on CT scans for head injury diagnosis may miss mild concussions not visible on imaging, potentially underestimating TBI incidence [ 14 , 18 ]. The male predominance (95%) reflects regional trauma demographics but limits generalisability to female patients, who may exhibit different injury patterns due to anatomical or behavioural differences [ 12 ]. Excluding patients with limb or chest injuries may skew the sample toward less severe systemic trauma, potentially inflating the observed protective effect of panfacial fractures [ 15 ]. Future research should employ prospective designs, include female patients, and use advanced imaging modalities, such as magnetic resonance imaging (MRI), to detect subtle TBIs [ 20 ]. Longitudinal studies could explore long-term neurological outcomes in panfacial versus isolated fracture patients to further elucidate the protective mechanism [ 3 ]. The regional context of Western Rajasthan, with its reliance on two-wheelers and limited road infrastructure, warrants targeted injury prevention studies [ 11 ]. Comparative analyses across regions or countries could determine if the protective effect of panfacial fractures is consistent across trauma aetiologies, such as falls or assaults [ 16 ]. Biomechanical modelling, as suggested by Pappachan et al. [ 3 ], could quantify how facial fracture patterns influence energy transmission to the cranium, potentially informing the design of trauma-specific helmets or facial guards for high-risk populations [ 10 ]. In summary, this study provides compelling evidence that panfacial fractures are associated with a lower incidence of head injuries compared to isolated facial bone fractures, likely due to the energy-dissipating properties of the facial skeleton [ 2 , 7 ]. These findings emphasise the need for tailored clinical protocols and robust public health measures to address the high burden of two-wheeler-related maxillofacial trauma in Western Rajasthan [ 9 , 11 ]. Conclusion Patients with panfacial fractures exhibit a significantly lower incidence of head injuries compared to those with isolated facial bone fractures, potentially due to the energy-dissipating effect of multiple facial fractures [ 7 ]. The predominance of two-wheeler RTAs underscores the need for stricter helmet enforcement and road safety measures in Western Rajasthan [ 9 , 11 ]. These findings highlight the importance of tailored trauma protocols for maxillofacial fracture patients Declarations IRB was waived by the ethical committee of Dr SNMEDICAL college Jodhpur as data was from anonymized Records References Singaram M, Vijayabala GS, Ganesan R. Patterns of maxillofacial fractures in road traffic accidents in a South Indian city. J Maxillofac Oral Surg. 2019;18(3):402-8. Lee KF, Wagner LK, Lee YE, Suh JH, Lee SR. The impact-absorbing effects of facial fractures in closed head injuries: an analysis based on computed tomography. J Neurosurg. 1987;66(4):542-7. Pappachan B, Alexander M. Correlating facial fractures and cranial injuries. J Oral Maxillofac Surg. 2006;64(7):1023-9. Follmar KE, Debruijn M, Baccarani A, Bruno AD, Mukundan S, Erdmann D, et al. Concomitant injuries in patients with panfacial fractures. J Trauma. 2007;63(4):831-5. Mundinger GS, Bellamy JL, Miller DT, Christy MR, Bojovic B, Dorafshar AH. Defining panfacial fractures: analysis of 33 cases. Plast Reconstr Surg. 2014;133(4 Suppl):1016. Erdmann D, Follmar KE, Debruijn M, Bruno AD, Jung SH, Edelman D, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. 2008;60(4):398-403. Keenan HT, Brundage SI, Thompson DC, Maier RV, Rivara FP. Does the face protect the brain? A case-control study of traumatic brain injury and facial fractures. Arch Surg. 1999;134(1):14-8. Martin RC 2nd, Spain DA, Richardson JD. Do facial fractures protect the brain or are they a marker for severe head injury? Am Surg. 2002;68(5):477-81. Bali RK, Sharma P, Garg A, Dhillon G. A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India. J Inj Violence Res. 2013;5(2):108-16. Singhal Y, Rao SS, Kumar S, Garg S. Pattern of maxillofacial injuries in road traffic accident cases in Western Uttar Pradesh: a prospective study. Indian J Dent Sci. 2016;8(3):133-7. Ugboko VI, Odusanya SA, Fagade OO. Maxillofacial fractures in a semi-urban Nigerian teaching hospital. Int J Oral Maxillofac Surg. 1998;27(4):286-9. Chandra Shekar BR, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated at two hospitals of Mysore city. Indian J Dent Res. 2008;19(4):304-8. Motamedi MH. An assessment of maxillofacial fractures: a 5-year study of 237 patients. J Oral Maxillofac Surg. 2003;61(1):61-4. Haug RH, Adams JM, Conforti PJ, Likavec MJ. Cranial fractures associated with facial fractures: a review of 2,143 cases. J Oral Maxillofac Surg. 1994;52(4):354-9. Obuekwe ON, Etetafia M. Associated injuries in patients with maxillofacial trauma: a study of 527 patients. Afr J Med Med Sci. 2005;34(2):175-9. Fasola AO, Nyako EA, Obiechina AE, Arotiba JT. Trends in the characteristics of maxillofacial fractures in Nigeria. J Oral Maxillofac Surg. 2003;61(10):1140-3. Bagheri SC, Dierks EJ, Kademani D, Holmgren E, Bell RB, Hommer L, et al. Application of a facial injury severity scale in craniomaxillofacial trauma. J Oral Maxillofac Surg. 2006;64(3):408-14. Davidoff G, Jakubowski M, Thomas D, Alpert M. The spectrum of closed-head injuries in facial trauma victims: incidence and impact. Ann Emerg Med. 1988;17(1):6-9. Zhang J, Moore AE, Stringer MD. The Facial Injury Severity Scale and its correlation with outcome in maxillofacial trauma. J Craniomaxillofac Surg. 2012;40(8):e450-4. Zargar M, Khaji A, Karbakhsh M, Zarei A. Epidemiology study of facial injuries during a 13-month period of trauma in Tehran. Indian J Med Sci. 2004;58(1):14-20. Additional Declarations The authors declare no competing interests. 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The facial skeleton, comprising the frontal, upper midface, lower midface, and mandibular subunits, lies in close proximity to the cranium, making traumatic brain injury (TBI) a common associated condition [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Panfacial fractures, defined as fractures involving at least three of the four facial subunits, are complex injuries typically resulting from high-velocity trauma [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In contrast, isolated facial bone fractures affect a single subunit, such as the mandible or zygoma [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Prior studies suggest that the facial skeleton may act as an energy-absorbing cushion, potentially reducing the risk of TBI in complex fractures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In India, particularly in Western Rajasthan, two-wheeler RTAs are a major contributor to maxillofacial trauma, exacerbated by high rates of helmet non-compliance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This study aims to compare the incidence of head injuries in patients with panfacial versus isolated facial bone fractures at a tertiary care centre in Western Rajasthan, where two-wheeler RTAs are a leading cause of trauma [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective cohort study was conducted at the Trauma Centre of a tertiary care hospital in Western Rajasthan. Medical records of patients treated for maxillofacial fractures between July 2023 and June 2025 were reviewed [13].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePatients aged \u0026ge;16 years with maxillofacial fractures (panfacial or isolated).\u003c/li\u003e\n \u003cli\u003eDiagnosed via clinical examination and computed tomography (CT) scans [14].\u003c/li\u003e\n \u003cli\u003eTreated at the tertiary care centre.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePatients \u0026lt;16 years.\u003c/li\u003e\n \u003cli\u003ePatients with associated limb or chest injuries [15].\u003c/li\u003e\n \u003cli\u003eIncomplete medical records or isolated soft tissue injuries.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were extracted from 650 patient records, including:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDemographics: Age, gender (95% male).\u003c/li\u003e\n \u003cli\u003eAetiology: Cause of trauma, with a focus on RTAs involving two-wheelers [16].\u003c/li\u003e\n \u003cli\u003eFracture Type: Classified as panfacial (fractures in \u0026ge;3 facial subunits: frontal, upper midface, lower midface, mandible) or isolated (single subunit fracture) [17].\u003c/li\u003e\n \u003cli\u003eHead Injury: Diagnosed via CT scans, classified as traumatic brain injury (TBI), including cerebral contusion, haemorrhage, or concussion [18].\u003c/li\u003e\n \u003cli\u003eFacial Injury Severity Scale (FISS): Used to quantify fracture severity (mild: 1-3, moderate: 4-7, severe: \u0026ge;8) [19].\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analysed using IBM SPSS Statistics version 22.0. Descriptive statistics summarised demographics and fracture patterns. Chi-square tests compared head injury incidence between panfacial and isolated fracture groups. Logistic regression assessed the association between fracture type and head injury, adjusting for age and aetiology [20]. A p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained at admission for research use. This is a retrospective study based on anonymised patient data only\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographics and Aetiology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 650 patients, 617 (95%) were male, with a mean age of 28.5 \u0026plusmn; 7.2 years (range: 16\u0026ndash;65 years). Two-wheeler RTAs were the primary aetiology (75%, n=488), followed by interpersonal violence (15%, n=98), falls (8%, n=52), and other causes (2%, n=12) [9]. Among RTA cases, 80% (n=390) involved two-wheelers, with 60% of these patients not using helmets [10].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFracture Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePanfacial Fractures: 180 patients (27.7%), with common sites including maxillary sinus wall (85%, n=153), mandible (80%, n=144), and zygomatic arch (70%, n=126) [17].\u003c/li\u003e\n \u003cli\u003eIsolated Fractures: 470 patients (72.3%), with mandible (40%, n=188), zygoma (30%, n=141), and nasal bones (20%, n=94) most affected [6].\u003c/li\u003e\n \u003cli\u003eFISS Scores: Panfacial fractures had a mean FISS score of 10.2 \u0026plusmn; 2.1 (severe category), while isolated fractures averaged 3.8 \u0026plusmn; 1.5 (mild to moderate category) (p\u0026lt;0.001) [19].\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eHead Injury Incidence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHead injuries, diagnosed as traumatic brain injury (TBI) via CT scans, occurred in 201 patients (30.9%) [18]. The incidence was significantly lower in the panfacial fracture group (20%, n=36/180) compared to the isolated fracture group (35%, n=165/470) (chi-square test, p=0.002) [7]. Common head injuries included cerebral contusion (45%, n=90), subdural hematoma (30%, n=60), and concussion (20%, n=40) [3].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Head Injury Incidence by Fracture Type\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFracture Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo Head Injury (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHead Injury (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePanfacial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e144 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIsolated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e305 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e165 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eCaption\u003c/em\u003e: Head injury incidence by fracture type, showing lower incidence in panfacial fractures (20%) compared to isolated fractures (35%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLogistic regression, adjusted for age and aetiology, confirmed that panfacial fractures were associated with a lower odds ratio of head injury (OR=0.47, 95% CI: 0.31\u0026ndash;0.72, p=0.001) [20]. Two-wheeler RTAs were a significant risk factor for head injury (OR=1.82, 95% CI: 1.25\u0026ndash;2.65, p=0.003) [11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Aetiology Distribution of Maxillofacial Fractures\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAetiology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Patients (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTwo-wheeler RTAs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInterpersonal Violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFalls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eCaption\u003c/em\u003e: Aetiology distribution of maxillofacial fractures, with two-wheeler RTAs as the leading cause (75%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe key finding of this study is that patients with panfacial fractures exhibit a significantly lower incidence of head injuries (20%) compared to those with isolated facial bone fractures (35%) (p\u0026thinsp;=\u0026thinsp;0.002) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This supports the hypothesis that the facial skeleton acts as a protective barrier, absorbing and dissipating traumatic energy before it reaches the cranium [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Biomechanical studies suggest that the complex structure of the facial bones, including the maxillary sinuses and multiple articulations, functions as a \"crumple zone,\" distributing impact forces across a broader area [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In panfacial fractures, involving multiple facial subunits (e.g., maxillary sinus wall, mandible, zygomatic arch), the cumulative fracture patterns may absorb a greater proportion of traumatic energy, reducing the force transmitted to the brain [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In contrast, isolated fractures, such as those of the mandible or zygoma, involve less bone surface area, allowing more energy to be transferred to the cranium, increasing the likelihood of traumatic brain injury (TBI) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis finding aligns with Keenan et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], who reported that facial fractures, particularly complex ones, are associated with a lower incidence of TBI (odds ratio 0.65) compared to cases without facial involvement. Lee et al. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] similarly demonstrated that facial fractures reduce the severity of closed head injuries, likely due to energy dissipation. However, Martin et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] suggest that facial fractures may indicate severe head injury in high-energy trauma, highlighting the need for context-specific analysis. The current study\u0026rsquo;s focus on panfacial versus isolated fractures and the exclusion of patients with limb or chest injuries may explain these differences, as associated injuries could confound the relationship between facial fractures and head injury [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe high prevalence of two-wheeler RTAs (75%), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, reflects the regional epidemiology of trauma in Western Rajasthan, where motorcycles are a dominant mode of transportation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The finding that 60% of two-wheeler RTA patients were not wearing helmets underscores a critical public health issue [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Helmet non-compliance increases the risk of both maxillofacial and head injuries, as helmets reduce TBI incidence by up to 40% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The severe FISS scores in panfacial fractures (mean 10.2, severe category) compared to isolated fractures (mean 3.8, mild to moderate category) indicate higher trauma energy in the former group, yet the lower head injury rate suggests that the complexity of panfacial fractures mitigates cranial impact [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This paradox may be explained by the biomechanical properties of the facial skeleton, where multiple fracture lines create a network of energy absorption, reducing force transmission to the neurocranium [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClinically, these findings have significant implications for trauma management. Patients with isolated facial fractures require prioritised neurological evaluation due to their higher head injury risk (35%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Conversely, while panfacial fractures demand complex surgical reconstruction, their lower association with head injuries may allow clinicians to focus on facial repair after ruling out life-threatening intracranial injuries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The predominance of two-wheeler RTAs highlights the urgent need for public health interventions, such as mandatory helmet laws and road safety campaigns, particularly in semi-urban and rural Western Rajasthan [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Educational programmes targeting young male riders, who constitute 95% of this cohort, could reduce maxillofacial trauma burden [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLimitations include the retrospective design, which introduces potential selection bias due to exclusion of patients with incomplete records or lost to follow-up [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Reliance on CT scans for head injury diagnosis may miss mild concussions not visible on imaging, potentially underestimating TBI incidence [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The male predominance (95%) reflects regional trauma demographics but limits generalisability to female patients, who may exhibit different injury patterns due to anatomical or behavioural differences [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Excluding patients with limb or chest injuries may skew the sample toward less severe systemic trauma, potentially inflating the observed protective effect of panfacial fractures [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Future research should employ prospective designs, include female patients, and use advanced imaging modalities, such as magnetic resonance imaging (MRI), to detect subtle TBIs [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Longitudinal studies could explore long-term neurological outcomes in panfacial versus isolated fracture patients to further elucidate the protective mechanism [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe regional context of Western Rajasthan, with its reliance on two-wheelers and limited road infrastructure, warrants targeted injury prevention studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Comparative analyses across regions or countries could determine if the protective effect of panfacial fractures is consistent across trauma aetiologies, such as falls or assaults [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Biomechanical modelling, as suggested by Pappachan et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], could quantify how facial fracture patterns influence energy transmission to the cranium, potentially informing the design of trauma-specific helmets or facial guards for high-risk populations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn summary, this study provides compelling evidence that panfacial fractures are associated with a lower incidence of head injuries compared to isolated facial bone fractures, likely due to the energy-dissipating properties of the facial skeleton [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These findings emphasise the need for tailored clinical protocols and robust public health measures to address the high burden of two-wheeler-related maxillofacial trauma in Western Rajasthan [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePatients with panfacial fractures exhibit a significantly lower incidence of head injuries compared to those with isolated facial bone fractures, potentially due to the energy-dissipating effect of multiple facial fractures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The predominance of two-wheeler RTAs underscores the need for stricter helmet enforcement and road safety measures in Western Rajasthan [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These findings highlight the importance of tailored trauma protocols for maxillofacial fracture patients\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eIRB was waived by the ethical committee of Dr SNMEDICAL college Jodhpur as data was from anonymized Records\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eSingaram M, Vijayabala GS, Ganesan R. Patterns of maxillofacial fractures in road traffic accidents in a South Indian city. J Maxillofac Oral Surg. 2019;18(3):402-8.\u003c/li\u003e\n \u003cli\u003eLee KF, Wagner LK, Lee YE, Suh JH, Lee SR. The impact-absorbing effects of facial fractures in closed head injuries: an analysis based on computed tomography. J Neurosurg. 1987;66(4):542-7.\u003c/li\u003e\n \u003cli\u003ePappachan B, Alexander M. Correlating facial fractures and cranial injuries. J Oral Maxillofac Surg. 2006;64(7):1023-9.\u003c/li\u003e\n \u003cli\u003eFollmar KE, Debruijn M, Baccarani A, Bruno AD, Mukundan S, Erdmann D, et al. Concomitant injuries in patients with panfacial fractures. J Trauma. 2007;63(4):831-5.\u003c/li\u003e\n \u003cli\u003eMundinger GS, Bellamy JL, Miller DT, Christy MR, Bojovic B, Dorafshar AH. Defining panfacial fractures: analysis of 33 cases. Plast Reconstr Surg. 2014;133(4 Suppl):1016.\u003c/li\u003e\n \u003cli\u003eErdmann D, Follmar KE, Debruijn M, Bruno AD, Jung SH, Edelman D, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. 2008;60(4):398-403.\u003c/li\u003e\n \u003cli\u003eKeenan HT, Brundage SI, Thompson DC, Maier RV, Rivara FP. Does the face protect the brain? A case-control study of traumatic brain injury and facial fractures. Arch Surg. 1999;134(1):14-8.\u003c/li\u003e\n \u003cli\u003eMartin RC 2nd, Spain DA, Richardson JD. Do facial fractures protect the brain or are they a marker for severe head injury? Am Surg. 2002;68(5):477-81.\u003c/li\u003e\n \u003cli\u003eBali RK, Sharma P, Garg A, Dhillon G. A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India. J Inj Violence Res. 2013;5(2):108-16.\u003c/li\u003e\n \u003cli\u003eSinghal Y, Rao SS, Kumar S, Garg S. Pattern of maxillofacial injuries in road traffic accident cases in Western Uttar Pradesh: a prospective study. Indian J Dent Sci. 2016;8(3):133-7.\u003c/li\u003e\n \u003cli\u003eUgboko VI, Odusanya SA, Fagade OO. Maxillofacial fractures in a semi-urban Nigerian teaching hospital. Int J Oral Maxillofac Surg. 1998;27(4):286-9.\u003c/li\u003e\n \u003cli\u003eChandra Shekar BR, Reddy C. A five-year retrospective statistical analysis of maxillofacial injuries in patients admitted and treated\u0026nbsp;at two hospitals of Mysore city. Indian J Dent Res. 2008;19(4):304-8.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"13\"\u003e\n \u003cli\u003eMotamedi MH. An assessment of maxillofacial fractures: a 5-year study of 237 patients. J Oral Maxillofac Surg. 2003;61(1):61-4.\u003c/li\u003e\n \u003cli\u003eHaug RH, Adams JM, Conforti PJ, Likavec MJ. Cranial fractures associated with facial fractures: a review of 2,143 cases. J Oral Maxillofac Surg. 1994;52(4):354-9.\u003c/li\u003e\n \u003cli\u003eObuekwe ON, Etetafia M. Associated injuries in patients with maxillofacial trauma: a study of 527 patients. Afr J Med Med Sci. 2005;34(2):175-9.\u003c/li\u003e\n \u003cli\u003eFasola AO, Nyako EA, Obiechina AE, Arotiba JT. Trends in the characteristics of maxillofacial fractures in Nigeria. J Oral Maxillofac Surg. 2003;61(10):1140-3.\u003c/li\u003e\n \u003cli\u003eBagheri SC, Dierks EJ, Kademani D, Holmgren E, Bell RB, Hommer L, et al. Application of a facial injury severity scale in craniomaxillofacial trauma. J Oral Maxillofac Surg. 2006;64(3):408-14.\u003c/li\u003e\n \u003cli\u003eDavidoff G, Jakubowski M, Thomas D, Alpert M. The spectrum of closed-head injuries in facial trauma victims: incidence and impact. Ann Emerg Med. 1988;17(1):6-9.\u003c/li\u003e\n \u003cli\u003eZhang J, Moore AE, Stringer MD. The Facial Injury Severity Scale and its correlation with outcome in maxillofacial trauma. J Craniomaxillofac Surg. 2012;40(8):e450-4.\u003c/li\u003e\n \u003cli\u003eZargar M, Khaji A, Karbakhsh M, Zarei A. Epidemiology study of facial injuries during a 13-month period of trauma in Tehran. Indian J Med Sci. 2004;58(1):14-20.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","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":"Maxillofacial fractures, Pan facial fractures, Isolated facial fractures, Head injury, Road traffic accidents, Two-wheelers","lastPublishedDoi":"10.21203/rs.3.rs-7326828/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7326828/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Maxillofacial fractures are common in trauma settings, often associated with head injuries due to the proximity of facial bones to the cranium. This study investigates whether patients with pan facial fractures (involving multiple facial subunits) have a lower incidence of head injuries compared to those with isolated facial bone fractures.\u003cbr\u003e\n\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective analysis was conducted on 650 trauma patients (95% male, aged ≥16 years) treated at a tertiary care centre in Western Rajasthan from July 2023 to June 2025. Patients with limb or chest injuries were excluded. Data on demographics, fracture type, head injury, and aetiology (predominantly road traffic accidents [RTAs] involving two-wheelers) were collected. The Facial Injury Severity Scale (FISS) was used to classify fracture severity. Statistical analysis included chi-square tests and logistic regression (p\u0026lt;0.05).\u003cbr\u003e\n\u003cstrong\u003eResults\u003c/strong\u003e: Of 650 patients, 180 (27.7%) had pan facial fractures, and 470 (72.3%) had isolated facial bone fractures. Head injuries were observed in 20% of pan facial fracture cases (36/180) versus 35% of isolated fracture cases (165/470) (p=0.002). RTAs, primarily involving two-wheelers, accounted for 75% of cases.\u003cbr\u003e\n\u003cstrong\u003eConclusion\u003c/strong\u003e: Patients with pan facial fractures have a significantly lower incidence of head injuries compared to those with isolated facial bone fractures, possibly due to the energy-dissipating effect of multiple facial fractures.\u003c/p\u003e","manuscriptTitle":"Associated Head Injury in Maxillofacial Fractures: A Retrospective Analysis Comparing Panfacial and Isolated Facial Bone Fractures\"","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2025-08-14 17:21:38","doi":"10.21203/rs.3.rs-7326828/v2","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}},{"code":1,"date":"2025-08-14 13:37:49","doi":"10.21203/rs.3.rs-7326828/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":"ac1a45a0-d21e-4d82-8b5a-9c3b5fdc72f4","owner":[],"postedDate":"August 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53184942,"name":"Dentistry"}],"tags":[],"updatedAt":"2025-08-14T13:37:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-14 17:21:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-7326828","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7326828","identity":"rs-7326828","version":["v2"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}