The published incidence of cervical spine injury (CSI) associated with facial fractures is variable and without clear consensus.  This study was designed to identify patterns of CSI in patients with craniofacial fractures.

Method: IRB retrospective review conducted over 7.8 years. Demographic data was collected including age, gender, mechanism of injury. The face was divided into thirds and CSI was classified according to cervical level (C1-C7). 

Results: 468 patients with CSI (9.4 %) were identified among 4,980 patients with facial fractures. The patients were predominantly male (74.5%) with a mean age of 41.6 years.  Motor vehicle collision (MVC) was the principal mechanism of injury. The following table outlines the percentage of cervical spine injuries per facial fracture level. 

%	C1	C2	C3	C4	C5	C6	C7
Lower	22.9	21.7	8.3	9.6	7.0	14.0	16.6
Middle	14.3	18.3	8.7	8.7	11.5	18.1	20.3
Upper	12.8	12.8	9.0	9.8	12.0	19.5	24.1

Conclusion: Facial fractures and concomitant CSI occurred in a predominantly young male population following MVC. Lower third facial fractures were associated with upper cervical spine injury (C1&C2) while upper and middle third facial fractures were associated with lower cervical spine injury (C6&C7).