Massive hemorrhage in facial fracture patients: definition, incidence, and management.

Background: Significant hemorrhage from fractures of the midface is a recognized phenomenon, but because it is an uncommon occurrence, there is little in the literature to guide management of these patients.
Methods: The authors performed a retrospective study of life-threatening hemorrhage in facial fracture patients attending the Royal Adelaide Hospital over 20 years and report four recent cases.
Results: The incidence of massive hemorrhage was found to be 0.33 percent of patients with fracture of the midface or skull base over the 20 years before 2004 and 1.7 percent in the subsequent year. Of the 19 patients identified from case notes and recent experience, seven died. In terms of management of hemorrhage, three patients had packing alone, 10 had balloon catheters inserted, and five had ligation of a vessel. Most patients had multiple other injuries, including six patients with head injuries. The mean number of units of packed red cells transfused was 9.5 (median, 7.5). In five of the cases identified, there was a delay in recognizing that facial fractures were the major source of hemorrhage.
Conclusions: Massive hemorrhage from facial fractures is an underrecognized and inconsistently managed phenomenon. Although low in incidence, its timely recognition and better management may reduce the high mortality rate in this group of patients.