The occurrence of facial fractures in women is less frequent compared with men. Literature has shown that 37% of women seen in the ED experience facial fractures. These women tend to be older, Caucasian, use Medicare coverage, and are treated in urban, metropolitan ED’s. Injuries occurred due to physical aggression, falls, motor vehicle accidents, sports, and work accidents. The etiology of facial fractures in women can also be characterized by age. The incidence of facial fractures is increasing in elderly women, most likely due to falls associated with the effects of aging and osteoporosis. ^,, Younger women tend to experience facial trauma due to intimate partner violence, which is also on the rise. In addition, there is a higher incidence of facial fractures among women who are unemployed, of lower socioeconomic status, and reside in a major city. ^, The overall annual financial burden of emergency care for facial fractures among women is $1.6 billion.

In sum, 34% to 92% of all facial traumas in children can be attributed to isolated trauma to the soft tissues of the craniofacial skeleton. Only 10% to 15% of those injuries result in facial fractures. The pediatric craniofacial skeleton is elastic, allowing for the natural protection of the face. ^,,, The most common etiologies of facial injuries in children and adolescents are from motor vehicle accidents, assault, accidental injuries, sports injuries, child abuse, and penetrating injuries. Forty-three percent of all facial injuries in children under the age of 5 are due to falls or accidental injuries. Unintentional injuries are the leading cause of morbidity and mortality in children and adolescents. Overall, pediatric trauma accounts for over 8 million visits to the ED annually, and more than 10% of all ED visits are a result of maxillofacial trauma. The global prevalence of maxillofacial trauma in children is due to road traffic crashes, falls, violence, and sports ( Fig. 1 ). An analysis from the National Trauma Data Bank found that the estimated prevalence of in-hospital mortality following facial injuries was 2.4% among children. In comparison to adult facial fractures, pediatric facial trauma can also be associated with significant health care burden and economic costs. ^,,

Global etiology of facial trauma in children and adolescents.

( Adapted from “Mohammadi H, Roochi MM, Heidar H, et al. A meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies among children and adolescents. Dent Traumatol 2023;39(5):403–417. https://doi.org/10.1111/edt.12845 ” with permission.)

The epidemiology and etiology of facial fractures have been widely studied in diverse populations. The frequency with which facial fractures occur in adult men and women, adolescents, and children is well understood. However, considerably less nuanced statistical analysis is available on the occurrence of facial trauma in individuals with intellectual and developmental disabilities. Traumatic dental injuries (TDIs) often occur due to participation in sports activities. TDIs are a subset of maxillofacial trauma that has also been well studied. Sports account for 4% to 41% of facial fractures and 0.8% to 26% of dental injuries worldwide

Individuals with intellectual and developmental disabilities and complex chronic diseases are known to be active participants in sports activities. For example, the Special Olympics is a global sports movement that advocates for the inclusive participation of individuals with and without intellectual disability in team sports. A recent study sought to examine the prevalence of TDIs in individuals with disabilities and co-existing diseases. The co-existing diseases included Down syndrome, cerebral palsy and/or epilepsy, ADHD, schizophrenia, and other rare diseases. They found that the most common TDIs involved enamel and enamel/dentin crown fractures in maxillary teeth, with a prevalence of 9% in the study group and 8% in the control group. Another study demonstrated similar findings, noting that the prevalence of TDIs was due to crown fracture. Other areas of concern regarding facial trauma in individuals with disabilities include self-injurious behavior.

Self-injurious behavior (SIB), refers to self-initiated actions that cause harm to oneself. Within the context of intellectual disability, autism supports, and services the term typically pertains to head banging, biting oneself, or hitting oneself with fists or objects. Dental practitioners become involved with self-injurious behavior when it becomes a causative factor in serious facial and oral trauma. Self-injurious behavior that is focused on the face and head can result in injuries varying from abrasions to dental fractures, blindness, and significant tissue loss

Published studies have yielded varying estimates of the point prevalence of self-injurious behaviors among people with intellectual disability and/or autism. Some early studies report the prevalence of self-injurious behavior among persons with intellectual disability and/or autism to be in excess of 20%; more conservative estimates are closer to 4% to 5%. ^, With regard to autism, prevalence estimates tend to range higher, up to 27.7%.

The imprecision of these prevalence studies is likely attributable to sampling differences. It is generally recognized that most individuals with intellectual disability present with the mildest form of SIB. In contrast, more severe presentations of SIB cases are strongly associated with more severe presentations of intellectual disability. Individuals with intellectual disabilities and/or autism are often not well represented by samples drawn exclusively from residential treatment centers, as only an estimated 15% of this population resides in these types of settings. In addition, residential support tends to be reserved for those with greater needs, suggesting that most individuals not in residential care are not as challenging in comparison to those receiving such care. Samples drawn from residential treatment centers are likely to overestimate the prevalence of SIB in the overall Intellectual Disability/Autism population. Perhaps the most reasonable conclusion is that some smaller subsample of the Intellectual Disability/Autism population engages in serious forms of SIB.

Evidence identified the 112 leading causes associated with the incidence and prevalence of facial fractures. They included falls, exposure to mechanical forces, interpersonal violence, other unintentional injuries, cyclist road injuries, motor vehicle road injuries, animal contact, motorcyclist road injuries, pedestrian road injuries, conflict and terrorism, foreign body in eyes, executions, and police conflict. Falls were the leading cause of all fractures across all age groups. Taylor and colleagues states that the most common etiologies of facial injuries in children and adolescents are motor vehicle accidents, assault, accidental injuries (blunt trauma from a fall), sports injuries, child abuse, and penetrating injuries. Motor vehicle accidents were the primary cause of facial injuries in children. Other evidence confirms that facial fractures due to road traffic accidents were the third leading cause of injury in adults, preceded by fractures resulting from falls and assault. ^,, The data sources used to identify the most common facial injury etiologies included the Global Disease Databank and the National Trauma Databank. ^,

The global rise in facial fractures, most commonly resulting from falls, motor vehicle accidents, sports injuries, and interpersonal violence, underscores the urgent need for continued advocacy and implementation of preventive strategies to reduce the burden of facial trauma. ^,,

The US Consumer Product Safety Commission operates the National Electronic Injury Surveillance System (NEISS), a statistically valid injury follow-back system that collects data on consumer product related injuries occurring in the United States. NEISS is based on a nationally representative probability sample of hospitals in the United States and its territories. The total number of product-related hospital emergency department visits nationwide can be estimated from the sample of cases reported in the NEISS. This system has become a valuable tool in public health research, capable of leveraging emergency department data to quantify sources of traumatic injuries by consumer products.

According to a 2023 NEISS data report, the highest rates of injuries in the United States were due to home structures, including stairs, ramps, landings, and floors. Adults aged 65+ demonstrated the highest rates of injury, followed by children aged 0 to 4. A recent study used NEISS data to specifically describe trends in facial injury data between 2017 and 2021. Researchers identified a significant downward trend in total injuries, however in comparison there was no significant change in the rate of facial injuries by year.

Demographically, males were more likely to experience a facial injury compared with women except for those age 65 and older. Whites were more likely to experience facial injury compared with African Americans, Asians, and American Indian/Alaskan Native and Native Hawaiian Pacific Islanders. Ethnicities were excluded due to inconsistencies in data availability. Older patients were more likely to experience hospitalizations due to facial injuries compared with younger patients. Injuries were more likely to occur at home due to falls and collisions. The most frequent source of facial injury across all age groups was building structures (including floors, ceilings, walls, and doors), followed by household furniture, and recreational tools and toys. Children younger than the age of 10 had facial injuries that were more likely to be caused by household furniture. Among patients between the ages of 10 to 20 and 21 to 40, the most common source of facial injury was recreational tools or toys, which included athletic equipment injuries. And for those ages 41 to 64 and older, facial injuries were more likely due to building structures.

Worldwide, public health campaigns and regulatory reforms have been implemented to encourage preventive practices and improve population health outcomes. In the first decade of the twenty-first century, the Centers for Disease Control and Prevention identified 10 public health achievements that significantly reduced the burden of disease, saved hundreds of lives, and resulted in billions of dollars in savings. As an example, motor vehicle safety was introduced as one of the 10 major public health achievements. Globally, motor vehicle accidents are one of the leading etiological factors contributing to facial trauma.

From 2001 to 2009, the observed decline in motor vehicle-related accidents was attributed to a combination of factors, including advancements in motor vehicle engineering, the enforcement of safety regulations, roadway enhancements, and the mandatory use of seatbelts and child safety seats. Personal behavioral modifications among motorists and pedestrians also played a crucial role in preventing traffic-related accidents. Concurrently, there were significant reductions in maxillofacial fractures following road traffic accidents. ^,, Therefore, meaningful associations can be linked to public health campaigns, regulatory reforms, and other prevention strategies to reduce facial fractures from MVAs. Our aim is to examine epidemiological patterns associated with facial trauma and describe evidence-based prevention strategies that represent current best practices. Various prevention strategies are examined within the framework of their underlying etiologies ( Table 1 ).