Concussion as the principal neurological component of combined craniofacial trauma

Combined craniofacial trauma is frequently accompanied by mild traumatic brain injury; however, concussion may remain unrecognized because clinically apparent facial skeletal injuries dominate the initial assessment and neurological manifestations are often nonspecific. The aim of this review was to summarize current evidence on the role of concussion in combined craniofacial trauma, its diagnostic features, functional consequences, and principles of multidisciplinary patient management. A narrative review of clinical guidelines, systematic reviews, meta-analyses, and clinical studies was conducted. The literature search was performed in PubMed/MEDLINE and the Cochrane Library using terms related to concussion, mild traumatic brain injury, maxillofacial and craniofacial trauma, post-concussive symptoms, and neurosensory disorders. The available evidence indicates that the risk of concomitant brain injury increases in high-energy trauma, whereas fractures of the middle and upper facial thirds may reflect substantial transmission of traumatic energy to the skull and brain. The clinical phenotype includes cerebral, cognitive, vestibular, neuro-ophthalmological, cervicogenic, and psycho-emotional manifestations, which may coexist with trigeminal or facial nerve injury, neurosensory deficits, pain, and functional limitations associated with fractures and maxillomandibular fixation. Failure to recognize concussion may delay recommendations concerning regimen, physical and cognitive activity, follow-up, and rehabilitation and may contribute to persistent headache, dizziness, cognitive difficulties, sleep disturbance, anxiety, and depressive symptoms. Concussion should therefore be regarded as a principal neurological component of combined craniofacial trauma requiring active screening, repeated clinical assessment, and coordinated multidisciplinary care.