{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:02:38Z","timestamp":1790150558376,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Dental Traumatology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early identification of patients at risk of severe head and neck injury following maxillofacial fractures is essential for clinical management. However, chronological age alone may not reflect injury severity or physiological vulnerability. This study aimed to identify an age threshold and evaluate injury mechanisms and fracture patterns associated with severe head and neck injury in patients with maxillofacial fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 712 patients with maxillofacial fractures. Severe head and neck injury was defined as an Abbreviated Injury Scale (AIS) score \u2265\u20093. Receiver operating characteristic (ROC) analysis was performed to identify the optimal age cut\u2010off for predicting severe head and neck injury. Patients were divided according to the ROC\u2010derived threshold. Facial injury severity was assessed using the Facial Injury Severity Scale (FISS). Multivariable logistic regression analysis was used to identify independent risk factors for severe head and neck injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ROC analysis suggested an optimal age threshold of 50\u2009years (area under the curve 0.61, 95% confidence interval 0.56\u20130.65). In patients aged \u2265\u200950\u2009years, falls from height (adjusted odds ratio [AOR] 8.67, 95% confidence interval [CI] 1.82\u201341.36,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) and traffic accidents (AOR 7.90, 95% CI 1.69\u201336.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009) were independent risk factors for severe head and neck injury. Orbital floor and rim fractures (AOR 1.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), naso\u2010orbital ethmoid fractures (AOR 2.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), and maxillary fractures (AOR 1.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049) were also independent risk factors. Median FISS scores were higher in the Severe group than in the Non\u2010severe group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A ROC\u2010derived age threshold of 50\u2009years may help identify patients at increased risk of severe head and neck injury. However, chronological age alone has limited predictive value. Injury mechanism, fracture patterns, and FISS should be considered together when assessing injury severity. The identified age threshold should be interpreted cautiously, and further external validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/edt.70134","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:17:03Z","timestamp":1790147823000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>ROC<\/scp>\n                    \u2010Derived Age Threshold, Injury Mechanisms, and Fracture Patterns Associated With Severe Head and Neck Injury in Patients With Maxillofacial Fractures"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7980-5156","authenticated-orcid":false,"given":"Miki","family":"Yamada","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Saitama Medical Center, Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3804-6122","authenticated-orcid":false,"given":"Yosuke","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Saitama Medical Center, Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9690-1713","authenticated-orcid":false,"given":"Shunsuke","family":"Hino","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery II Nihon University School of Dentistry  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3846-5714","authenticated-orcid":false,"given":"Makoto","family":"Murase","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care Saitama Medical Center, Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1354-9313","authenticated-orcid":false,"given":"Norio","family":"Horie","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Saitama Medical Center, Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Sawano","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care Saitama Medical Center, Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Saitama Medical Center, Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/ger.12410","article-title":"Changing Trends in Epidemiology and Management of Facial Trauma in a Swiss Geriatric Population","volume":"36","author":"Burkhard J. P. M.","year":"2019","journal-title":"Gerodontology"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/j.joms.2022.04.018","article-title":"Are the Elderly With Maxillofacial Injuries at Increased Risk of Associated Injuries?","volume":"80","author":"Kokko L. L.","year":"2022","journal-title":"Journal of Oral and Maxillofacial Surgery"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/j.1754-4505.2006.tb01715.x","article-title":"Fractures of the Mandible in the Aging Population","volume":"26","author":"Sidal T.","year":"2006","journal-title":"Special Care in Dentistry"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/edt.12917","article-title":"World Trends in Publication for Maxillofacial and Dental Trauma in the Elderly","volume":"40","author":"Turino F. D.","year":"2024","journal-title":"Dental Traumatology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.joms.2013.11.018","article-title":"Trends in Maxillofacial Trauma: A Comparison of Two Cohorts of Patients at a Single Institution 20\u2009Years Apart","volume":"72","author":"Martinez A. Y.","year":"2014","journal-title":"Journal of Oral and Maxillofacial Surgery"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/SCS.0b013e31824cd383","article-title":"Risk Factors for Death in Elderly Patients With Facial Fractures Secondary to Falls","volume":"23","author":"Clavijo\u2010Alvarez J. A.","year":"2012","journal-title":"Journal of Craniofacial Surgery"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s00068-015-0557-1","article-title":"Impact of Age on the Clinical Outcomes of Major Trauma","volume":"42","author":"Hildebrand F.","year":"2016","journal-title":"European Journal of Trauma and Emergency Surgery"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.arr.2023.101934","article-title":"60\u2009Years of Healthy Aging: On Definitions, Biomarkers, Scores and Challenges","volume":"88","author":"Behr L. C.","year":"2023","journal-title":"Ageing Research Reviews"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/S0140-6736(14)61464-1","article-title":"Macroeconomic Implications of Population Ageing and Selected Policy Responses","volume":"385","author":"Bloom D. 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S.","year":"2016","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jcms.2019.01.004","article-title":"The Cfi Score: Validation of a New Comprehensive Severity Scoring System for Facial Injuries","volume":"47","author":"Canzi G.","year":"2019","journal-title":"Journal of Craniomaxillofacial Surgery"}],"container-title":["Dental Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/edt.70134","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/edt.70134","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/edt.70134","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:17:06Z","timestamp":1790147826000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/edt.70134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":22,"alternative-id":["10.1111\/edt.70134"],"URL":"https:\/\/doi.org\/10.1111\/edt.70134","archive":["Portico"],"relation":{},"ISSN":["1600-4469","1600-9657"],"issn-type":[{"value":"1600-4469","type":"print"},{"value":"1600-9657","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"assertion":[{"value":"2026-06-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"edt.70134"}}