ROC-Derived Age Threshold, Injury Mechanisms, and Fracture Patterns Associated With Severe Head and Neck Injury in Patients With Maxillofacial Fractures.

BACKGROUND: Early identification of patients at risk of severe head and neck injury following maxillofacial fractures is essential for clinical management. However, chronological age alone may not reflect injury severity or physiological vulnerability. This study aimed to identify an age threshold and evaluate injury mechanisms and fracture patterns associated with severe head and neck injury in patients with maxillofacial fractures. MATERIALS AND METHODS: We retrospectively analyzed 712 patients with maxillofacial fractures. Severe head and neck injury was defined as an Abbreviated Injury Scale (AIS) score ≥ 3. Receiver operating characteristic (ROC) analysis was performed to identify the optimal age cut-off for predicting severe head and neck injury. Patients were divided according to the ROC-derived threshold. Facial injury severity was assessed using the Facial Injury Severity Scale (FISS). Multivariable logistic regression analysis was used to identify independent risk factors for severe head and neck injury. RESULTS: ROC analysis suggested an optimal age threshold of 50 years (area under the curve 0.61, 95% confidence interval 0.56-0.65). In patients aged ≥ 50 years, falls from height (adjusted odds ratio [AOR] 8.67, 95% confidence interval [CI] 1.82-41.36, p = 0.007) and traffic accidents (AOR 7.90, 95% CI 1.69-36.86, p = 0.009) were independent risk factors for severe head and neck injury. Orbital floor and rim fractures (AOR 1.78, p = 0.04), naso-orbital ethmoid fractures (AOR 2.29, p = 0.02), and maxillary fractures (AOR 1.78, p = 0.049) were also independent risk factors. Median FISS scores were higher in the Severe group than in the Non-severe group (p = 0.006). CONCLUSION: A ROC-derived age threshold of 50 years may help identify patients at increased risk of severe head and neck injury. However, chronological age alone has limited predictive value. Injury mechanism, fracture patterns, and FISS should be considered together when assessing injury severity. The identified age threshold should be interpreted cautiously, and further external validation is warranted.