Document Type


Date of Degree

Fall 2011

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Torner, James C

First Committee Member

Torner, James C

Second Committee Member

Peek-Asa, Corinne

Third Committee Member

Chrischilles, Elizabeth A

Fourth Committee Member

Ramirez, Marizen

Fifth Committee Member

Phillips, Kirk T

Sixth Committee Member

Sahr, Sheryl M

Seventh Committee Member

Janus, Todd J


Facial fractures are commonly present in hospital patients admitted for trauma care. The establishment of clinical indicators for uncovering facial fractures has been insufficiently studied. The main objectives of this study were to determine midface facial fracture diagnostics, etiology, characteristics, indicators, related outcomes, and treatments within a trauma patient population. A clinical epidemiologic study was conducted using a retrospective observational design. Level I trauma center data was used from the years of 2007-2009. Key data sources were Iowa Methodist Trauma registry, radiographic scans and notes, electronic medical records, and billing records. A case-control and a retrospective cohort design were used to address study objectives. Analyses included bivariate comparative tests along with multivariate logistic regression modeling.

The study demonstrated that the majority of facial fractures in the patient population were diagnosed with maxillofacial computed tomography scans. Patients had a median of 2 (interquartile range: 2-4) facial fractures with the orbit bones being the most commonly fractured bones. Of patients with fracture, 48% had a direct or indirect health outcome related to their fracture and 51% of patients had their fracture left to self-resolve with minimal self-care. Statistically significant indicators of facial fracture included the presence of periorbital contusion, open wound of the forehead, epistaxis, blood in ethmoid sinus, and blood in maxillary sinus, while motor vehicle collision appeared to have a disproportionately low relationship with fracture. Based on these risk factors, three potential risk groups for facial fracture were proposed, stratifying study patients into subpopulations per their estimated risk level. Study results will help clinicians better understand facial fracture. The revealed indicators and risk levels for facial fracture may serve to help determine when fractures may be present in similar trauma patient populations. Further research should be conducted to validate the internal validity as well as the generalizability of study results in other trauma centers and patients.


Diagnostics, Facial Fracture, Indicators, Prevention, Trauma


2, xiii, 150 pages


Includes bibliographical references (pages 146-150).


Copyright 2011 Hayden Lee Smith