Cervical Spine Fractures with Maxillofacial Trauma

In a motor vehicle accident, there is often more than one injury. In the case of maxillofacial injuries, which happen when the face is thrust forward onto the steering wheel, dashboard or the back of the front seat, the neck is also forwardly flexed, leading in some cases to cervical spine injuries. What this means is that, in cases of obvious maxillofacial trauma, the doctor needs to have a higher index of suspicion for a cervical spine injury.

In maxillofacial trauma, the bone injured the most in concomitant neck injuries is the mandible. This is the jaw bone that opens and closes at the level of the temporomandibular joint in order to allow for chewing. Fractures can happen in the coronoid process, the condyle, the ramus, the body or the symphysis, in the central part of the front of the mandible. In 91 percent of cases where there was both a facial fracture and a cervical fracture, it was the mandible that was fractured.

Cervical fractures happen when the head and neck are flexed sharply forward, leading to a vertebral body fracture, although fractures of the vertebral processes can also occur. The biggest risk of a fractured cervical spine is subluxation of one vertebral body over another, which can sever the spinal cord or severely narrow the cord so that a blood clot or mere compression can damage the cord. This results in quadriplegia.

In one study, the incidence of concomitant maxillofacial fractures and cervical fractures was looked at, in part because these patients have a high mortality rate and rates of neurological difficulties if not dealt with correctly. A total of 563 patients with facial fractures were looked at. These cases also showed a cervical fracture eleven times for a total of 2 percent. The vast majority of patients were men and most were between 20 and 35 years (64 percent). These patients were involved in a motor vehicle accident 91 percent of the time.

What this means is that facial fracture patients should also have a C spine x-ray before being removed from cervical restraints. If a C spine x-ray is equivocal, the patient should have a CT scan of the face and neck to further elucidate the degree of facial injury and to rule out cervical injury. This should be done even if no cervical neurological findings are noted on examination.

There should be a cooperative effort between orthopedic surgeons/trauma surgeons and maxillofacial surgeons or ENT specialists. Surgery to stabilize the cervical spine and to put together the damaged facial bones can be done together with both physicians participating.

The patient will have a long road to recovery and may need a cervical halo on top of teeth that are wired shut for an extended period of time. Multiple surgeries on the C spine may need to be done besides the first one which stabilizes the joint and there may be a prolonged hospitalization in order to learn how to function with a halo and with a liquid diet that may be necessary for up to 2-3 months.

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