According to the World Health Organization (WHO), individuals aged 65 years and older are considered elderly. With increasing life expectancy and a growing population of active older adults, trauma-related hospitalizations have become an important public health concern, with substantial morbidity and socioeconomic consequences ^[1,2].

Maxillofacial trauma in geriatric patients presents unique challenges compared with younger populations. Although facial injuries are more frequent among younger individuals, their occurrence in older adults is increasing with longer life expectancy and greater physical activity ^[2-4]. Falls are the most common cause of facial trauma in the elderly and may result in significant facial fractures, particularly of the mandible and midface ^[1,3,5]. Age-related reductions in vision, balance, muscle strength, coordination, and protective reflexes further increase susceptibility to falls and trauma ^[5,6].

The consequences of maxillofacial trauma are often more severe in elderly patients because of reduced physiological reserve and multiple age-related comorbidities. Cardiovascular disease, osteoporosis, reduced muscle mass, impaired vision, and other chronic conditions may complicate injury management and recovery ^[2,6,7]. Elderly patients also have a greater risk of associated injuries, particularly following high-energy trauma, and may require prolonged hospitalization and more intensive monitoring ^[8].

Airway management is a critical component of maxillofacial trauma care, particularly when facial fractures, bleeding, soft-tissue swelling, or associated cervical spine injuries are present ^[8,9]. Computed tomography (CT) is essential for accurately defining the extent of cranio-maxillofacial injuries and identifying associated skeletal damage. Following stabilization, treatment should be individualized according to fracture severity, functional impairment, comorbidities, and the patient's overall physiological condition ^[9-11].

Management of geriatric maxillofacial trauma requires careful balancing of functional restoration with the increased risks associated with surgery and anesthesia. Conservative treatment may be appropriate for selected stable fractures, whereas surgical intervention may be required for displaced fractures, malocclusion, functional impairment, or significant aesthetic deformity ^[3,4,10].

Previous studies have highlighted the distinctive patterns and management challenges of cranio-maxillofacial trauma in older adults, particularly the predominance of falls, increased associated injuries, comorbidities, and reduced physiological tolerance to trauma and surgical intervention ^{[2,3,6,8,10].} Despite these concerns, evidence regarding geriatric maxillofacial trauma remains limited, particularly in developing countries.

In Bangladesh, data on maxillofacial trauma among geriatric patients are scarce. This study therefore aimed to assess the clinical characteristics, causes, injury patterns, associated injuries, management approaches, and outcomes of maxillofacial trauma in geriatric patients.

Study Design and Study Period This was a retrospective observational study conducted to evaluate the clinical characteristics, management challenges, treatment strategies, and outcomes of geriatric patients with maxillofacial trauma. The study was conducted using hospital records of patients treated between January 2007 and December 2008. The study period represented the period from which the clinical records of eligible patients were reviewed, while protocol development, literature review, data extraction, and statistical analysis were performed separately. Study Place and Population The study was conducted in the Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study population comprised geriatric patients aged 60 years or older who presented with maxillofacial trauma and received treatment at BSMMU during the study period. Patients were identified from hospital records, emergency records, inpatient files, operative records, radiological reports, discharge summaries, and available follow-up records. A total of 36 patients fulfilling the eligibility criteria were included in the final analysis. Eligibility Criteria and Data Collection Patients aged 60 years or older with a documented diagnosis of maxillofacial trauma and adequate clinical records were included. Patients younger than 60 years, those with isolated non-maxillofacial trauma, duplicate records, inadequate clinical information, or follow-up records for injuries treated outside the study period or at another institution were excluded. Data were retrospectively collected using a structured data collection form. Information regarding demographic characteristics, mechanism of injury, pre-existing comorbidities, fracture sites, associated injuries, treatment modality, type of anesthesia, timing of definitive treatment, management challenges, postoperative complications, hospital stay, and functional outcome was extracted from the available medical records. Assessment of Management Challenges and Treatment Outcomes The management challenges were assessed from documented clinical information and included significant medical comorbidities, requirement for preoperative medical optimization, delay of definitive treatment beyond 48 hours, increased anesthetic risk, difficulty with postoperative mobilization, and prolonged hospital stay of more than 7 days. These factors were considered non-mutually exclusive because an individual patient could experience more than one challenge. Treatment was categorized as conservative management, open reduction and internal fixation (ORIF), or closed reduction/minor procedure. For surgically treated patients, the type of anesthesia and time from admission to definitive treatment were also recorded. Treatment outcomes included postoperative complications, duration of hospital stay, and functional recovery at the final documented follow-up. Functional outcome was categorized as satisfactory recovery, mild residual functional limitation, or significant residual functional problem based on the clinical documentation. Statistical Analysis Data were entered into a computerized database and analyzed using IBM SPSS Statistics version 16. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages. Variables permitting multiple responses, including comorbidities, fracture sites, associated injuries, and management challenges, were analyzed independently; therefore, their percentages could exceed 100%. Given the retrospective design and relatively small sample size, the analysis was primarily descriptive. Ethical Considerations Ethical approval was obtained from the appropriate Institutional Review Board/Ethics Committee of Bangabandhu Sheikh Mujib Medical University (BSMMU) before review of the patient records. As the study involved retrospective analysis of previously recorded clinical information, informed consent was waived where permitted by the ethics committee. Patient confidentiality was maintained throughout the study, and no personally identifiable information was included in the analytical dataset.

During the study period, a total of 36 geriatric patients with maxillofacial trauma were included in the retrospective analysis.

Table 1 shows the mean age of the patients was 68.9 ± 5.2 years, with an age range of 60–82 years. Most patients were male (25, 69.4%), while 11 (30.6%) were female. The largest proportion belonged to the 65–69-year age group (12, 33.3%), followed by the 70–74-year group (10, 27.8%). Twenty patients (55.6%) were from urban areas and 16 (44.4%) were from rural areas.

Table 1. Demographic characteristics of the study patients (n=36)

Table 2 shows the most common mechanism of injury was fall from standing height, accounting for 15 patients (41.7%), followed by road traffic accidents in 10 (27.8%). Falls from stairs or elevated surfaces occurred in 6 patients (16.7%), while interpersonal violence and other causes accounted for 3 (8.3%) and 2 (5.6%) patients, respectively. Medical comorbidities were common in the study population. Hypertension was the most frequent comorbidity (18, 50.0%), followed by diabetes mellitus (11, 30.6%) and ischemic heart disease (7, 19.4%). Overall, 25 patients (69.4%) had at least one major comorbidity, whereas 11 (30.6%) had no major documented comorbidity.

Table 2. Mechanism of injury and comorbidities among study patients (n=36)

*Multiple comorbidities were possible; therefore, percentages do not total 100%.

Table 3 presents the mandible was the most frequently affected anatomical site, identified in 18 patients (50.0%), followed by the zygomaticomaxillary complex in 9 (25.0%), nasal bone in 8 (22.2%), maxilla in 7 (19.4%), and orbit in 6 (16.7%). Frontal bone fractures were identified in 3 patients (8.3%). Multiple fracture sites occurred in some patients. Among the 18 patients with mandibular fractures, the body/angle region was the most frequently involved site (8, 44.4%), followed by the condylar region (6, 33.3%) and symphysis/parasymphysis (4, 22.2%).

Table 3. Anatomical distribution of maxillofacial fractures (n=36)

Multiple fracture sites could occur in the same patient; therefore, the fracture-site frequencies do not total 36.

Table 4 shows associated injuries were present in 15 patients (41.7%), while 21 (58.3%) had isolated maxillofacial trauma. Upper-limb injuries were the most frequent associated injuries (7, 19.4%), followed by lower-limb injuries (5, 13.9%) and head injury or concussion (4, 11.1%). Chest and other injuries were each documented in 2 patients (5.6%).

Several factors presented additional challenges in the management of these geriatric patients. Significant medical comorbidity requiring consideration during treatment was present in 18 patients (50.0%), while 14 (38.9%) required preoperative medical optimization. Definitive treatment was delayed beyond 48 hours in 11 patients (30.6%), and increased anesthetic risk was identified in 9 (25.0%). Difficulty with postoperative mobilization and prolonged hospital stay were each observed in 8 patients (22.2%).

Table 4. Associated injuries and geriatric-specific management challenges (n=36)

*Management challenges could overlap; therefore, percentages do not total 100%.

Table 5 shows regarding treatment, 23 patients (63.9%) required surgical management, whereas 13 (36.1%) were managed conservatively. ORIF was the most frequently used treatment modality, performed in 17 patients (47.2% of the total study population), while 6 (16.7%) underwent closed reduction or another minor procedure. Among the 23 surgically managed patients, general anesthesia was used in 15 (65.2%) and local anesthesia with or without sedation in 8 (34.8%). The mean interval from admission to definitive treatment was 2.8 ± 1.6 days. Among surgically treated patients, 12 (52.2%) received definitive treatment within 2 days, 8 (34.8%) within 3–5 days, and 3 (13.0%) after more than 5 days.

Table 5. Management strategies among the study patients

Table 6 shows post-treatment complications were documented in 9 patients (25.0%), while 27 (75.0%) had no recorded complication. Surgical-site infection was the most frequent complication (3, 8.3%), followed by wound dehiscence and malocclusion (2, 5.6% each). Respiratory or cardiovascular complications occurred in 2 patients (5.6%). No perioperative mortality was recorded. The mean hospital stay was 6.1 ± 3.4 days overall. Patients managed conservatively had a shorter mean hospital stay (4.3 ± 1.8 days) compared with those undergoing surgical treatment (7.1 ± 3.7 days). At final documented follow-up, 29 patients (80.6%) achieved satisfactory functional recovery, while 5 (13.9%) had mild residual functional limitations and 2 (5.6%) had significant residual problems.

Table 6. Treatment outcomes, complications, hospital stay, and functional recovery

Overall, geriatric maxillofacial trauma in this cohort was predominantly associated with falls and a high prevalence of medical comorbidity. Mandibular fractures were the most common injury pattern. The management of these patients was complicated by medical comorbidities, the need for preoperative optimization, anesthetic considerations, delayed definitive treatment, and postoperative functional challenges. Despite these difficulties, most patients achieved satisfactory functional recovery, although one-quarter experienced at least one post-treatment complication.

In the present study, the mean age was 68.9 ± 5.2 years, with males predominating and the 65–69-year group being most common. Similar male predominance among elderly patients with facial fractures has been reported in previous studies [12,13]. Falls from standing height were the leading mechanism of injury, followed by road traffic accidents. This finding agrees with studies identifying falls as a major cause of maxillofacial fractures in elderly patients [14,15]. The predominance of falls may be related to age-related impairments in balance, vision, muscle strength, and protective reflexes. Comorbidities were common, with hypertension being the most frequent, and 69.4% of patients had at least one major comorbidity. Previous studies have similarly reported that systemic disease and reduced physiological reserve increase the complexity and risks of trauma management in elderly patients [15,16]. The mandible was the most frequently affected site, followed by the zygomaticomaxillary complex and nasal bone. These findings are consistent with previous reports describing mandibular and midfacial fractures as common patterns in elderly trauma [13,14]. Associated injuries occurred in 41.7% of patients, mainly involving the limbs. This is consistent with previous studies showing that elderly patients with facial trauma frequently sustain concomitant injuries [12-14]. Medical optimization, increased anesthetic risk, treatment delays, and difficulty with postoperative mobilization further complicated management. Surgical treatment was required in 63.9% of patients, with ORIF being the most common modality. Previous studies have emphasized that treatment should be individualized according to fracture severity, systemic health, and functional status [12,14,15]. Post-treatment complications occurred in 25.0%, most commonly surgical-site infection. The mean hospital stay was 6.1 ± 3.4 days, with longer stays among surgically treated patients, consistent with the importance of injury severity and treatment requirements reported [12]. Despite these challenges, 80.6% achieved satisfactory functional recovery and no perioperative mortality occurred. Overall, geriatric maxillofacial trauma was predominantly associated with falls, comorbidities, and mandibular fractures. Despite considerable management challenges, individualized multidisciplinary care resulted in generally favorable functional outcomes.

Geriatric maxillofacial trauma was frequently associated with falls, mandibular fractures, multiple comorbidities, and associated injuries, creating significant challenges in treatment planning and perioperative care. Despite these challenges and the occurrence of postoperative complications, individualized and multidisciplinary management enabled most patients to achieve satisfactory functional recovery, supporting the feasibility of appropriate surgical and conservative treatment in carefully selected elderly patients.