Clinical and Radiologic Predictors of Surgical Intervention in Adult Maxillofacial Trauma Patients Presenting to the Emergency Department

Purpose: Maxillofacial trauma may be managed either conservatively or surgically. This study aimed to identify the clinical and radiologic factors associated with operative management in adult patients and to propose a practical, emergency department-based treatment approach. Methods: This retrospective cohort study included adult patients who presented with head and facial trauma between March 1, 2021, and March 1, 2026. Patients aged 18 years or older who had clinical findings suggestive of maxillofacial injury and who underwent maxillofacial computed tomography (CT) were included. Demographic data, trauma mechanism, Glasgow Coma Scale (GCS) score, forensic status, CT findings, consultation, hospitalization, mortality, and treatment were recorded. Patients were divided into operative and nonoperative groups. Descriptive statistics, between-group comparisons, and multivariable logistic regression were performed. Results: A total of 855 patients were included. The mean age was 59.06±22.38 years, and 499 patients (58.4%) were female. Falls were the most common mechanism of injury (74.15%). Surgery was performed in 32 patients (3.74%). Compared with nonoperatively managed patients, those who underwent surgery were younger, more frequently male, had lower GCS scores, and were more often forensic cases. A radiologically confirmed fracture was the strongest independent factor associated with surgery [odds ratio (OR)=11.29; P =0.001], together with forensic status and a lower GCS score. Among patients with radiologically confirmed facial fractures, mandibular, orbital, and nasal fractures were each independently associated with surgery (OR=44.70, 6.54, and 4.44, respectively; all P ≤0.004). Conclusion: Most adult patients with maxillofacial trauma were managed nonoperatively. A radiologically confirmed fracture, forensic status, a lower GCS score, and specific fracture locations—mandibular, orbital, and nasal—may help guide early surgical evaluation and support a simple, practical treatment algorithm.