Introduction : Although methods for classifying facial fractures have been extensively described in the literature, corresponding classification systems for Major Maxillofacial Wounds (MMW) are few. We present our primary results on application of the new classification system MOXAIC for MMW.

Patients and methods : A retrospective study was conducted on patients with MMW who underwent emergency surgery at Viet Duc University hospital from 11/2004 to 12/2008. MMW were defined as wounds longer than 10 cm involving at least one of craniofacial bones, carotid artery, parotid gland or duct, facial nerve or eye. Injuries were reviewed in order to find common patterns. Treatment success was assessed with respect to restoration of anatomy, function and aesthetics.

Results : Case notes from 118 patients were assessed. Five patterns of injury were identified, each group sharing characteristics of location, directionality, number of anatomical units involved, severity, treatment approach, results and prognosis. A letter was allocated to each injury type to reflect the shape of the injury pattern. The five injury types of the Major Maxillofacial Wound classification system MOXAIC are as follows: Type O: Circumferential wound (less severe; 83.4% good treatment outcome). Type X: Oblique wound (multidisciplinary approach required; 55.9% good treatment outcome). Type A: Arched wound (airway often compromised; 81.2% good treatment outcome). Type I: Direct penetrative wound (airway often compromised, extensive blood loss; 57.1% good treatment outcome). Type C: Cut wound (early control of bleeding required; 87.5% good treatment outcome).

Conclusion : The MOXAIC system is easy to use, reproducible and facilitates treatment decision and prognosis estimation. The proposed classification system would benefit from further review and reproduction of research with a prospective, multicenter methodology.