Ten years of war: a characterization of craniomaxillofacial injuries incurred during operations Enduring Freedom and Iraqi Freedom

J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S453-8. doi: 10.1097/TA.0b013e3182754868.


Background: Improved armor and battlefield medicine have led to better survival in the wars in Iraq and Afghanistan than any previous ones. Increased frequency and severity of craniomaxillofacial injuries have been proposed. A comprehensive characterization of the injury pattern sustained during this 10-year period to the craniomaxillofacial region is needed to improve our understanding of these unique injuries, to optimize the treatment for these patients, and to potentially direct strategic development of protective equipment in the future.

Methods: The Joint Theater Trauma Registry was queried from October 19, 2001, to March 27, 2011, covering operations Enduring Freedom and Iraqi Freedom for battle injuries to the craniomaxillofacial region, including patient demographics and mechanism of injury. Injuries were classified according to type (wounds, fractures, burns, vascular injuries, and nerve injuries) using DRG International Classification of Diseases-9th Rev. diagnosis codes.

Results: In this 10-year period, craniomaxillofacial battle injuries to the head and neck were found in 42.2% of patients evacuated out of theater. There is a high preponderance of multiple wounds and open fractures in this region. The primary mechanism of injury involved explosive devices, followed by ballistic trauma.

Conclusion: Modern combat, characterized by blast injuries, results in higher than previously reported incidence of injury to the craniomaxillofacial region.

Level of evidence: Epidemiologic study, level IV.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Afghan Campaign 2001-
  • Blast Injuries / epidemiology*
  • Databases, Factual
  • Facial Injuries / diagnosis
  • Facial Injuries / epidemiology*
  • Facial Injuries / surgery
  • Female
  • Humans
  • Injury Severity Score
  • Iraq War, 2003-2011
  • Male
  • Mass Casualty Incidents / mortality
  • Mass Casualty Incidents / statistics & numerical data
  • Maxilla / injuries*
  • Military Personnel / statistics & numerical data
  • Multiple Trauma / diagnosis
  • Multiple Trauma / epidemiology*
  • Multiple Trauma / surgery
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Skull Fractures / diagnosis
  • Skull Fractures / epidemiology*
  • Skull Fractures / surgery
  • Survival Analysis
  • Treatment Outcome
  • United States / epidemiology
  • Warfare*
  • Young Adult