Craniomaxillofacial Injuries in Northwestern Ontario, Canada: A Narrative Review of Epidemiology, Mechanisms, Regional Challenges and Contemporary Management

Craniomaxillofacial (CMF) trauma represents a complex component of acute surgical care because injuries to the facial skeleton frequently occur in association with traumatic brain injury, cervical spine injury, ocular trauma, airway compromise and other multisystem injuries. The management of these injuries in Northwestern Ontario presents additional challenges related to the region's large geographic area, rural and remote populations, transportation distances and accessibility, environmental conditions and concentration of subspecialty trauma services in Thunder Bay. Objective To review the epidemiology, mechanisms, anatomical patterns, acute management, surgical treatment and prevention of CMF injuries in Northwestern Ontario, with consideration of the unique geographic and demographic characteristics of the region. Methods A narrative review of the available literature concerning CMF trauma in Northwestern Ontario was undertaken, supplemented by relevant Canadian and international literature addressing facial fracture assessment, imaging, multidisciplinary trauma management and prevention. Particular emphasis was placed on regional studies involving patients treated at Thunder Bay Regional Health Sciences Centre (TBRHSC). Results A 10-year retrospective review of 1077 CMF injuries managed at TBRHSC identified young adult males as the predominant injured population. Interpersonal violence was the leading mechanism of injury, with alcohol and drug use identified as important associated factors. Mandibular fractures were the most frequent fracture pattern, followed by malar and dentoalveolar injuries. A recurrent injury rate of approximately 7% was reported. Motor vehicle collisions represent the second most common mechanism, with wildlife-related collisions providing a distinctive regional pattern. Previous Canadian research demonstrated that occupants involved in moose-related collisions had a significantly greater risk of maxillofacial injury and fracture than occupants involved in other high-speed motor vehicle collisions. Conclusions CMF trauma in Northwestern Ontario reflects both the epidemiology of facial trauma seen elsewhere and mechanisms unique to northern Canada. Effective management requires a coordinated regional trauma system incorporating early stabilization, timely transfer, multidisciplinary surgical care, rehabilitation and injury prevention. Future research should update the epidemiology of CMF trauma in the region and evaluate changes in injury mechanisms, demographics, access to care and treatment outcomes over the past decade