{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:31:31Z","timestamp":1786354291455,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background\/Objectives: The present investigation was designed and conducted with the aim to evaluate the statistical significance of the Comprehensive Facial Injury (CFI) score in relation to total surgical time (ST), length of hospital stay (LOS), and the presence of head injury in patients with fractures of the maxillofacial skeleton. Methods: The study includes 332 patients with maxillofacial fractures, a subset of whom also had associated head injuries. The CFI score was calculated for each patient. The Kolmogorov\u2013Smirnov test was applied to assess the distribution of score values within the cohort. The Kruskal\u2013Wallis H test was used to compare ST (minutes), LOS (days), and Glasgow Coma Scale (GCS) scores across different CFI score groups. Statistical significance was defined as p &lt; 0.05. Results: The majority of the patients were male, at 77.1%, with 22.9% female. The mean age was 36.4 years, with a standard deviation of 19.3 years. Definitive surgical treatment was performed in 58.7% of patients, while the remaining 41.3% were managed conservatively (with closed reduction and external fixation) or received no surgical intervention. A statistically significant association was found between the CFI score and both ST and LOS (p &lt; 0.001). Associated head injury was found in 33 patients or 9.9%. Furthermore, significant correlations were observed between CFI score values and Glasgow Coma Scale scores (p &lt; 0.001) as well as the presence of head injury (p &lt; 0.001). Conclusions: In conclusion, the CFI score provides a straightforward and comprehensive framework for assessing both operative duration and hospitalization length in patients with maxillofacial trauma. Moderate correlations between the CFI score and all investigated variables support its reliability in assessing trauma severity. The CFI score may therefore be useful in guiding treatment planning and developing standardized clinical protocols. However, its predictive capacity requires further validation in future studies.<\/jats:p>","DOI":"10.3390\/reports9030263","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:08:53Z","timestamp":1786349333000},"page":"263","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying the Severity of Facial Trauma in a Bulgarian Cohort Using the Comprehensive Facial Injury Score"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8413-3939","authenticated-orcid":false,"given":"Ventseslav","family":"Ralev","sequence":"first","affiliation":[{"name":"Maxillofacial Surgery Unit, MBAL \u201cDr. Ivan Seliminski\u201d, \u201cHristo Botev\u201d Str. 1, 8800 Sliven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_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","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1016\/j.jcms.2019.07.005","article-title":"Understanding the relevance of comprehensive facial injury (CFI) score: Statistical analysis of overall surgical time and length of stay outcomes","volume":"47","author":"Canzi","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Canzi, G., Aseni, P., De Ponti, E., Cimbanassi, S., Sammartano, F., Novelli, G., and Sozzi, D. (2022). The Comprehensive Facial Injury (CFI) Score Is an Early Predictor of the Management for Mild, Moderate and Severe Facial Trauma. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123281"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4103\/njms.njms_306_21","article-title":"Comprehensive facial injury (CFI) score as a predictor of surgical time, length of hospital stay, and head injury? Our experience at level I trauma center","volume":"13","author":"Rawat","year":"2022","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1280.e1","DOI":"10.1016\/j.joms.2018.02.002","article-title":"Can a facial stability injury scale be used to predict the need of surgical intervention and time of hospitalization?","volume":"76","author":"Aita","year":"2018","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/SLA.0000000000000624","article-title":"Hospital length of stay after admission for traumatic injury in Canada: A multicenter cohort study","volume":"260","author":"Moore","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/SAP.0000000000001818","article-title":"Implementation of a trauma quality improvement program communications package decreases time-to-operation for facial trauma","volume":"82","author":"Keller","year":"2019","journal-title":"Ann. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1186\/s13018-024-05066-3","article-title":"Prolonged operative time significantly impacts on the incidence of complications in spinal surgery","volume":"19","author":"Monetta","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"112041","DOI":"10.1016\/j.injury.2024.112041","article-title":"Can trauma scores predict the length of hospital stay of patients with fractures after earthquake-related blunt injury?","volume":"56","author":"Dalkir","year":"2025","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1186\/2047-783X-14-12-532","article-title":"Working Group on Polytrauma (NIS) of the German Trauma Soceity (DGU). Duration and predictors of emergency surgical operations--basis for medical management of mass casualty incidents","volume":"14","author":"Lefering","year":"2009","journal-title":"Eur. J. Med. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"542","DOI":"10.3171\/jns.1987.66.4.0542","article-title":"The impact-absorbing effects of facial fractures in closed-head injuries: An analysis of 210 patients","volume":"66","author":"Lee","year":"1987","journal-title":"J. Neurosurg."},{"key":"ref_12","first-page":"18","article-title":"The relationship between mid-face fractures and brain injuries","volume":"13","author":"Sigaroudi","year":"2012","journal-title":"J. Dent. Shiraz Univ. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1001\/archsurg.134.1.14","article-title":"Does the face protect the brain? A case control study of traumatic brain injury and facial fractures","volume":"134","author":"Keenan","year":"1999","journal-title":"Arch. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1177\/000313480206800517","article-title":"Do facial fractures protect the brain or are they markers for severe head injury?","volume":"68","author":"Martin","year":"2002","journal-title":"Am. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1067\/mem.2003.1","article-title":"Facial trauma and the risk of intracranial injury in motorcycle riders","volume":"41","author":"Kraus","year":"2003","journal-title":"Ann. Emerg. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1111\/edt.12052","article-title":"Maxillofacial injuries and traumatic brain injury\u2014A pilot study","volume":"30","author":"Rajandram","year":"2014","journal-title":"Dent. Traumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1080\/10903127.2024.2381048","article-title":"Early Glasgow Coma Scale Score and Prediction of Traumatic Brain Injury: A Secondary Analysis of Three Harmonized Prehospital Randomized Clinical Trials","volume":"29","author":"Iyanna","year":"2025","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S1010-5182(02)00168-3","article-title":"Cranio-maxillofacial trauma: A 10 year review of 9543 cases with 21,067 injuries","volume":"31","author":"Gassner","year":"2003","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e517","DOI":"10.1097\/SCS.0000000000006719","article-title":"Epidemiology and Pattern of Oral and Maxillofacial Trauma","volume":"31","author":"Wusiman","year":"2020","journal-title":"J. Craniofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Khan, T.U., Rahat, S., Khan, Z.A., Shahid, L., Banouri, S.S., and Muhammad, N. (2022). Etiology and pattern of maxillofacial trauma. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0275515"},{"key":"ref_21","first-page":"412","article-title":"Patterns of facial fractures and associated soft tissue injuries: A retrospective study on 1007 patients","volume":"61","author":"Juncar","year":"2022","journal-title":"Acta Clin. Croat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0007-1226(89)90107-0","article-title":"Computer-based coding of fractures in the craniofacial region","volume":"42","author":"Cooter","year":"1989","journal-title":"Br. J. Plast. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ijom.2005.06.019","article-title":"Maxillofacial injury severity score: Proposal of a new scoring system","volume":"35","author":"Zhang","year":"2006","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_24","first-page":"1024","article-title":"The design and implementation of chinese maxillofacial trauma registry, analysis and injury severity score system","volume":"64","author":"Zhaohui","year":"2008","journal-title":"J. Trauma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.joms.2005.11.013","article-title":"Application of a facial injury severity scale in craniomaxillofacial trauma","volume":"64","author":"Bagheri","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1097\/SCS.0b013e3181e1b3c1","article-title":"A new system for severity scoring of facial fractures: Development and validation","volume":"21","author":"Catapano","year":"2010","journal-title":"J. Craniofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.joms.2006.03.051","article-title":"The mandible injury severity score: Development and validity","volume":"65","author":"Shetty","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1016\/j.jcms.2019.03.021","article-title":"Open versus closed treatment for unilateral mandibular extra-capsular condylar fractures: A meta-analysis","volume":"47","author":"Li","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1016\/j.joms.2008.06.107","article-title":"Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: A randomized, prospective, multicenter study with special evaluation of fracture level","volume":"66","author":"Schneider","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_30","first-page":"e215","article-title":"Etiology, Modalities of Zygomaticomaxillary Complex Fracture, open reduction and fixation","volume":"13","author":"Rohit","year":"2021","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1055\/s-0041-1735816","article-title":"LeFort Fractures","volume":"35","author":"Ikeda","year":"2021","journal-title":"Semin Plast. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.joms.2018.11.027","article-title":"Is the mandible injury severity score a valid measure of mandibular injury severity?","volume":"77","author":"Nishimoto","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_33","first-page":"831","article-title":"Concomitant injuries in patients with panfacial fractures","volume":"63","author":"Follmar","year":"2007","journal-title":"J. Trauma"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/0007-1226(93)90191-D","article-title":"Associated injuries in facial fractures: Review of 839 patients","volume":"46","author":"Lim","year":"1993","journal-title":"Br. J. Plast. Surg."},{"key":"ref_35","first-page":"587","article-title":"A nationwide review of the associations among cervical spine injuries, head injuries, and facial fractures","volume":"68","author":"Mulligan","year":"2010","journal-title":"J. Trauma"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1177\/000313481808400840","article-title":"Is the Face an Air Bag for the Brain and Torso?\u2014The Potential Protective Effects of Severe Midface Fractures","volume":"84","author":"Woriax","year":"2018","journal-title":"Am. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s12663-017-1078-8","article-title":"Brain injuries and facial fractures: A prospective study of incidence of head injury associated with maxillofacial trauma","volume":"17","author":"Joshi","year":"2018","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"R143","DOI":"10.1186\/cc13976","article-title":"Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: A retrospective analysis of 30,157 cases","volume":"18","author":"Just","year":"2014","journal-title":"Crit. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1016\/j.injury.2019.09.007","article-title":"Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses","volume":"50","author":"Higgins","year":"2019","journal-title":"Injury"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jcrc.2020.08.003","article-title":"What factors predict length of stay in the intensive care unit? Systematic review and meta-analysis","volume":"60","author":"Peres","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_41","first-page":"e0757","article-title":"A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs","volume":"4","author":"Nazer","year":"2022","journal-title":"Crit. Care Explor."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"i27","DOI":"10.1136\/injuryprev-2019-043297","article-title":"Epidemiology of facial fractures: Incidence, prevalence and years lived with disability estimates from the Global Burden of Disease 2017 study","volume":"26","author":"Lalloo","year":"2020","journal-title":"Inj. Prev."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/263\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:52:13Z","timestamp":1786351933000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":42,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["reports9030263"],"URL":"https:\/\/doi.org\/10.3390\/reports9030263","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}