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| LETTER TO EDITOR |
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| Year : 2014 | Volume
: 5
| Issue : 2 | Page : 201-202 |
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Incidence of cervical spine injury in maxillofacial trauma
Mohammad Akheel, Suryapratap Singh Tomar
Department of Oral and Maxillofacial Surgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| Date of Web Publication | 1-Jul-2014 |
Correspondence Address:
Mohammad Akheel
Block 5, 4H, VGN Laparasiene, Nolambur, Mogappair West, Chennai - 600 037, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-9727.135814
How to cite this article:
Akheel M, Tomar SS. Incidence of cervical spine injury in maxillofacial trauma. Muller J Med Sci Res 2014;5:201-2 |
Dear Editor,
Life-threatening cervical spine injury with its devastating consequences is often overlooked by oral and maxillofacial surgeons during primary evaluation of maxillofacial trauma. The presence or absence of a cervical spine injury has important implications in maxillofacial trauma patients, influencing airway management, choice of diagnostic imaging studies, timing for surgical approach, and treatment of concomitant facial fractures. There is general agreement that immediate management of cervical spine injuries is mandatory to prevent further neurological deficits.
A 37-year-old male reported to the department following a car accident. Since he was unconscious and his Glasgow Come Scale was 10/15, the patient was intubated orally to maintain the airway. Clinical examination revealed multiple facial fractures and facial lacerations, with no other signs of external injuries. Computed tomography brain revealed an extradural hematoma in the right frontal region. Computed tomography of paranasal nasal sinus view of skull revealed Le Fort II fractures, with bilateral angle fracture of the mandible. Rest of his medical history was non-contributory. On referral to a neurosurgeon, who advised cervical spine X-ray, it revealed complete transaction of third and fourth cervical vertebrae (C3 and C4). The patient was immediately transferred to department of neurosurgery for further management.
Hackl et al., reported an incidence of 19.2% of cervical spine injuries and dislocations in his study of 3083 patients. [1] Mulligan et al., reported an incidence of 4.9-8% of cervical spine injuries in his study of 1.3 million trauma patients. [2] Depending on type of fractures of facial thirds, it is estimated that the second vertebra is most commonly injured, accounting for 24% of fractures; the sixth and seventh vertebrae together account for another 39% of fractures. [3] This letter underlines the importance of proper clinical and computed tomographic evaluation in cases of maxillofacial fractures for identification of additional cervical spine trauma. Detection of cervical spine trauma can be overlooked, especially when pain or symptoms from other parts of the body are dominant. Concomitant cervical spine injury may delay treatment of facial fractures and must be managed immediately by stabilizing the cord initially and then planning for fixation.
Hence, each oral and maxillofacial surgeon must evaluate all the maxillofacial fractures with underlying cervical spine injuries and head injuries. Each maxillofacial fracture must require a neurosurgeon opinion and clearance for fixation of the facial injuries to avoid postoperative life-threatening complications.
| References | |  |
| 1. | Hackl W, Hausberger K, Sailer R, Ulmer H, Gassner R. Prevalence of cervical spine injuries in patients with facial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:370-6. 
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| 2. | Mulligan RP, Mahabir RC. The prevalence of cervical spine injury, head injury, or both with isolated and multiple craniomaxillofacial fractures. Plast Reconstr Surg 2010;126:1647-51.
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| 3. | Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR. NEXUS Group. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med 2001;38:17-21.
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