A total of 611 patients were retrospectively reviewed. Among them, 392 were male (64%) and 219 were female (36%), with a male-to-female ratio of 1.79:1. The mean patient age was 57.5 years (SD ± 23.4), with cases approximately equally distributed across all age groups [13,14,15].

The overall incidence of DTMI was 20.2% (124 out of 611 patients). Of these, 76 patients (61%) were correctly identified in the initial CT reports, while 48 patients (39%) were detected only during retrospective review. Among the 124 patients with DTMI, a total of 147 traumatic findings were recorded, comprising 97 (78,2%) facial bone injuries and 50 (40,3%) dental injuries. Lesion-based analysis revealed an overall detection of 59% (87 out of 147 lesions). When analyzed separately, the detection rate for maxillofacial injuries was 77% (75 out of 97), whereas dental trauma was detected in only 24% of cases (12 out of 50).

The most frequently detected type of dental trauma was enamel-dentin fracture (A3), found in 15 of 50 cases (30%), followed by alveolar process fractures and crown-root fractures with pulpal involvement, each observed in 5 cases (10%) (Fig. 3). Among periodontal injuries, the most common lesion was extrusive dislocation (B3), observed in 6 cases (12%). Supporting bone injuries (C3) represented the most frequent form of osseous trauma, accounting for 15 of 50 cases (30%) (Fig. 4).

A, B: crown fracture of 2.1, 2.2 (A3 in Andreasen classification). C, D: Fracture extending from tooth 1.1 to 1.4, involving the nasal bones and the right maxilla (A6B6 in Andreasen classification)

Dental lesions found according to Andresen [1]:

Facial bone involvement was predominantly localized in the midface region. Upper central midface partition (UCMP), involving the nasal bone, septum and upper ethmoid wall, were observed in 70 patients (72%), followed by orbital midface partition (OMP), involving all orbital walls, observed in 27 patients (28%) and intermediate central midface partition (ICMP), involving anterior maxillary wall and inferior orbital floor observed in 25 patients (26%) (Figs. 5 and 6).

Maxillofacial lesions found according to AO-CMF* 11 :

A, B: Displaced tooth within the maxillary sinus (B6 in Andreasen classification, 94 C in AO-CMF classification); C,D: Right condyle and parasymphysis fracture with concomitant dental avulsion (B6C3 in Andreasen classification, 91 A,91 F in AO-CMF classification)

A Chi-square goodness-of-fit test revealed a statistically significant deviation in the distribution of dental trauma types (χ² = 68.00, df = 16, p < 0.0001). Further pairwise Chi-square analyses showed that enamel-dentin fractures (A3) and supporting bone fractures (C3) were significantly more frequent than other trauma types (χ² = 24.41, df = 1, p = 0.0001). Similarly, grouped midfacial fractures types (UCMP, OMP, ICMP) showed a significantly overrepresentation (χ² = 10.69, df = 1, p = 0.0011).

Among the 124 patients with DTMI, 25 had no other associated lesions; 33 had neuroradiologically relevant associated injuries (15 involving the brain, 8 the spine, and 10 both brain and spine); 20 had body injuries requiring general radiological or interventional evaluation; 29 had combined neuro-body injuries; and 18 were considered completely negative for other traumatic findings at the initial CT.

A statistically significant and strong association was found between the presence of associated injuries (e.g., brain, spine, body) and positive maxillofacial findings at admission CT (χ² ≈ 85; p < 0.0001; Cramér’s V = 0.82). This finding suggests that maxillofacial injuries are more likely to be detected when associated with other severe injuries, while isolated cases are at greater risk of being overlooked.

Regarding the timing of admission, 81 out of 124 trauma patients (65,3%) presented during daytime hours. Among these, 42 cases (51,9%) were identified at admission, while 39 cases (48,1%) were identified only during retrospective review. In contrast 43 out of 124 trauma patients (34,7%) occurred during the nighttime hours, with 19 cases (44,2%) identified at admission and 24 cases (55,8%) identified retrospectively. The association between shift time (day vs. night) and detection timing was weak and not statistically significant (Cramér’s V = 0.073; OR = 1.36; χ² = 0.654; p > 0.05), suggesting a non-significant trend toward slightly improved detection during daytime.

The analysis revealed the presence of multiple concomitant traumatic injuries, suggesting a potential correlation with DTMI.

Notably, a statistically significant association was observed between DTMI and traumatic brain injuries, particularly intracranial hemorrhages, including intraparenchymal, subarachnoid, and subdural bleeding.

Vertebral dislocations are frequently observed in high-energy polytrauma and contribute to complex clinical presentations in which maxillofacial and dental injuries may be initially underestimated or diagnosed late. Concomitant thoracoabdominal injuries—such as pulmonary, hepatic, and splenic contusions, as well as pneumothorax, pneumomediastinum, hemoperitoneum, and hemothorax—are commonly reported, often secondary to rib and pelvic fractures or severe visceral trauma. These associated lesions reflect the transmission of substantial kinetic energy throughout the body, increasing the risk of maxillofacial involvement and complicating both diagnosis and timely management of facial and dental injuries.