Evolution of maxillofacial fractures before, during, and after the COVID-19 pandemic: an 8-year interrupted time series analysis from South-Western Romania

BACKGROUND: The COVID-19 pandemic altered trauma epidemiology worldwide. Although reductions in maxillofacial trauma during lockdown periods have been widely reported, longitudinal changes in trauma characteristics and post-pandemic recovery remain insufficiently explored. This study evaluated temporal changes in maxillofacial trauma volume and injury characteristics across pre-COVID, COVID, and post-COVID periods using an interrupted time series (ITS) framework. METHODS: A retrospective observational study was conducted at a tertiary maxillofacial surgery center in Romania, including patients treated between December 2017 and November 2025. Cases were categorized into pre-COVID, COVID, and post-COVID phases. Variables included fracture patterns, trauma etiology, associated head and neck injuries, polytrauma, and treatment modality. Comparative analyses were performed using chi-square analyses with Bonferroni correction. ITS regression analysis was applied to assess temporal changes in monthly trauma volume. RESULTS: A total of 914 patients were included. ITS analysis suggested a temporary reduction in trauma volume during the COVID period, followed by post-pandemic recovery; however, several model parameters demonstrated borderline statistical significance and the model showed limited explanatory power. Descriptive analyses demonstrated persistent differences in trauma characteristics across study periods, including lower proportions of associated injuries and documented polytrauma in the post-COVID period compared with pre-pandemic values. ORIF procedures decreased during the COVID period and increased thereafter. CONCLUSIONS: The COVID-19 pandemic was associated with a temporary reduction in maxillofacial trauma volume, followed by post-pandemic recovery. Although overall trauma volume recovered, trauma characteristics differed across study periods. These findings should be interpreted cautiously given the variability of trauma epidemiology and the limitations of the ITS model. Further studies incorporating standardized severity measures and more advanced time-series methodologies are warranted.