The rise in incidence of head, face and neck injuries from the twentieth to the twenty-first century is well documented . Reviews from Iraq and Afghanistan since 2003 have reported rates of head, face and neck injuries between 21% and 29% . Definitions of what constitutes a maxillofacial wound have been unclear and this has led to difficulties in comparing maxillofacial injury statistics between conflicts.

D obson et al. analysed military maxillofacial injuries between 1914 and 1986 but acknowledged that conclusive data were missing in 80% of the conflicts and used the terms ‘head and neck’ and ‘maxillofacial’ interchangeably leading to ambiguity. Current anatomical classifications used by UK and US military forces use the broad category ‘head’ to describe injuries ranging from intracranial and scalp wounds to base of skull and vault fractures. Of these, only scalp wounds are generally considered maxillofacial injuries, the remainder being traditionally considered neurosurgical. The category ‘face’ includes ophthalmic and ear injuries as well as bony facial trauma. R amasamy et al. found that the face accounted for 10% of injuries presenting to a field hospital in Iraq in 2006. They found that head wounds accounted for a further 5% but as they did not differentiate between scalp and intracranial injury it is not possible to estimate a true incidence of maxillofacial injury. Maxillofacial injuries represented 13% of British battle injuries evacuated to the UK between 2005 and 2007 . L ew et al. analysed all US cranio-maxillofacial wounds between 2001 and 2007, finding the incidence to be 26%. Careful analysis of the injury description codes used in their paper show that neck wounds were included, which does not fit into the classical British definition of a ‘maxillofacial’ wound. Table 1 shows the only papers detailing ‘maxillofacial’ injuries and excludes intracranial, ophthalmic and neck injuries. The most common cause of maxillofacial battle injuries is now from improvised explosive devices . These wounds are generally well resisted by torso body armour and helmets, leaving the face exposed.

UK service personnel sustaining maxillofacial wounds in Afghanistan are stabilised in either the UK field hospital in Camp Bastion or the multinational field hospital in Kandahar. They are evacuated by aeroplane to the UK for definitive treatment at the Royal Centre for Defence Medicine based at University Hospitals Birmingham NHS Foundation Trust. The surgical workload of a single British field hospital in Iraq has been described but no British paper in the twenty-first century has specifically described the treatment of military maxillofacial wounds either in Afghanistan or the UK. The aim of this paper is to describe the management of maxillofacial wounds sustained by UK service personnel and to compare management between the field hospitals in Afghanistan and following evacuation to the UK.