Epidemiology of Maxillofacial Injuries in the Swords of Iron War: Insights From a National Registry

Background: Maxillofacial injuries (MFI) in warfare present significant challenges due to the concentration of vital structures in the facial region and the high-energy mechanisms of injury. This study analyzes the epidemiology, severity, and outcomes of MFI during the Swords of Iron conflict using data from the Israeli National Trauma Registry. Methods: A retrospective analysis was conducted on casualties from October 7, 2023 to August 1, 2024. Injury characteristics, surgical interventions, intensive care unit (ICU) admissions, and mortality rates were assessed. Logistic regression identified predictors for severe head injury and surgical intervention. Results: Of 1654 casualties, 324 (19.6%) sustained MFI, predominantly from explosions (85.2%). Fractures were associated with higher ICU admission rates (60.6% vs. 20.0%, p < 0.0001) and greater surgical intervention requirements (65.4% vs. 36.4%, p = 0.0001) than soft tissue injuries. Orbital fractures (59.6%) were the most common and strongly correlated with severe head injury (OR 9.33, CI 4.29–21.54, p < 0.001). Zygomatic (OR 8.47), maxillary (OR 5.81), and mandibular fractures (OR 12.61) significantly predicted the need for surgery, whereas orbital fractures often did not. Airway management was required in 26.5% of MFI cases, significantly higher than in other injuries (12.6%, p < 0.001). The overall mortality rate was low, with 7.7% in the fracture group and 0.9% in the soft tissue injury group. Conclusion: MFI in combat settings demands specialized trauma care, particularly for fractures requiring surgical intervention and intensive care. The high prevalence of orbital fractures and their association with severe head injuries highlight the need for early recognition and intervention despite their being less prone to surgical correction. These findings can inform trauma care protocols to optimize management and outcomes in future conflicts.