Characteristics of Maxillofacial Trauma Resulting from Terror

Objectives: The article characterizes maxillofacial injuries as a result of terrorist acts in Israel during a 33 month period. We compare terror casualties with other maxillofacial injuries resulting from non-terror trauma. Methods: Data on all patients who were hospitalized between October 1, 2000 and June 30, 2003 was obtained from the Israel National Trauma Registry (9 of 23 trauma centers, all six level 1 trauma centers in Israel and three level 2 trauma centers). The parameters evaluated were: patients' age and sex, type of injury, mechanism of injury, severity of injuries, diagnosis, duration of hospitalization, the need of surgical and other procedures in the operating room, stay in intensive-care unit and outcome. Findings were compared with hospitalized non-terror related trauma population within the same time period. Literature survey was conducted to compare our findings to other reports from different regions. Result: During the study period 1811 terror casualties were recorded into the trauma registry. The majority of terror casualties were between the ages 15-29 with male predominance (75.5%). In 493 of the patients with terror injuries (27.2%) the diagnoses included injuries of the face. This group consisted of 322 patients (17.8%) that their diagnoses included injuries to the soft tissue of the face (excluding eye and ear injuries), and 104 patients (5.7%) that their diagnoses included injury to hard tissues of the maxillofacial complex. We found significantly higher prevalence of injuries in terror casualties than in non-terror related casualties (non-terror casualties: 13.8%, 8.8% 3.4% respectively). The injury mechanism consisted mainly of explosions and gunshot injuries. Most of the casualties suffered from multiple injuries. Conclusions: Maxillofacial terror casualties experience a unique epidemiology with more severe injuries and higher prevalence of injuries to the soft and to the hard tissues. Preparedness and awareness to the unique pattern of the injuries are needed.