Conference Coverage

Orbital Floor Fractures Surpass Nasal Bone Injuries as the Most Common Facial Trauma in Elderly Patients

Anthony Calabro, MA

Key Highlights

  • Isolated orbital floor fractures were the most common facial fracture in elderly patients (≥ 65 years) at Puerto Rico’s only Level I Trauma Center.
  • Falls accounted for 87.6% of injuries, with women disproportionately affected (68.8%).
  • Incidence of orbital floor fractures increased significantly from 2021 to 2022, while prevalence remained stable.
  • The right orbital floor was more frequently involved than the left (53% vs 46.8%).

Over a 3-year period, researchers found that orbital floor fractures were the most common facial fractures in elderly patients presenting to Puerto Rico’s only Level I Trauma Center, surpassing the traditionally cited nasal bone fractures. Falls emerged as the predominant cause of these injuries, particularly among women, with incidence significantly increasing over time despite stable prevalence.

The study, presented by Alvaro J. Horta Caicedo, DMD, and colleagues at the 107th American Association of Oral and Maxillofacial Surgeons Annual Meeting, Scientific Sessions and Exhibition in Washington, DC, addressed a critical shift in the understanding of facial trauma among older adults. Historically, nasal bone fractures have been considered the most common, largely due to the anatomical prominence of the nasal pyramid. However, demographic changes, specifically the doubling of Puerto Rico’s elderly population since 2010, combined with increased fall-related risks associated with aging, necessitated a reevaluation of facial trauma patterns.

The investigators conducted a retrospective cohort analysis of electronic health records from 2020 to 2022 at Administración de Servicios Médicos (ASEM), the island’s only Level I Trauma Center. Patients aged 65 years or older with isolated orbital floor fractures confirmed by oral and maxillofacial surgeons were included. Cases with multiple facial fractures or incomplete medical records were excluded. Statistical analyses included chi-square testing (P < .05) to assess prevalence and incidence trends, alongside descriptive statistics.

From 1958 consultations, 218 cases met inclusion criteria. The mean age of patients was 78.8 years (SD, 8), with women comprising nearly 70% of cases. Prevalence rates per 1,000,000 population were 2.04%, 2.2%, and 2.5% for 2020, 2021, and 2022, respectively. Incidence rose from 0.3 in 2021 to 0.9 in 2022, a statistically significant increase (P = .020). Right-sided orbital floor fractures slightly outnumbered left-sided cases (53% vs 46.8%). Falls were responsible for 87.6% of injuries, though motor vehicle accidents and assaults were more frequently documented in men (5.9%).

“While literature typically reports nasal bone fractures as the most common facial trauma in emergency settings, our study found that isolated orbital floor fractures were more prevalent among elderly patients in Puerto Rico,” the authors concluded.

Reference
Horta Caicedo AJ, Castellanos Ferrer J, Bermudez F, Peña-Ruiz OA. Shifting patterns in facial trauma among the elderly: orbital floor fractures as the most common injury. Abstract presented at: 107th American Association of Oral and Maxillofacial Surgeons Annual Meeting, Scientific Sessions and Exhibition; Washington, DC; 2025. https://aaoms-annual-meeting-2025.eventscribe.net/