Our study has shown that more than 55% of those having facial injuires in our setting are young males who were involved in road traffic collsions or falls from height. Severe injuries that necessitated admission to the ICU with reduced GCS were highly significant in those who died. The most important factor prediciting mortality of patients having facial injuires was the low GCS. Those having GCS of 8 and more had a better chance for survival. This can be explained by the association between facial and head injuries. This information is very important when counselling patients or their relatives for facial surgery.
Similar to others, young males were the highest risk group for facial injuries in our study [1-3]. Nevertheless, the male-to-female ratio was 6.8:1 which is much higher than other studies[13-15]. The demography of our setting is very unique. The fast economic growth of the UAE required the employment of male foreign workers for construction projects. They constitute 78% of the population . Similar to others, RTC is the leading cause of facial injuries [3,11,12]. RTC is the second cause of death in the UAE  which is caused by aggressive driving and poor seatbelt compliance [17, 18]. This was followed by fall from height which is caused by low safety measures in the workplace .
The highest number of injuries occurred around 7:00 p.m because Al-Ain City traffic is highly active during this time. Our City is spread horizontally over an area of 30 km by 25 km because it is not allowed to have more than four storey buildings in the residential areas. There are wide highways of 3-lanes having a speed limit of 80km/hour within the city. In contrast to others [20,21], there was no increase in the incidence of facial injuries during the weekends. Furthermore, facial injuries peaked in winter. Winter in the UAE is the most pleasant season with a nice weather encouraging families to have desert sport activities using quad bike riding which has high frequency of facial injuires . In contrast, facial injuries are more common in the summer months in China and Canada [20,21].
Asscociated injuries are common in patients having facial injuries [6, 5, 23]. They occurred in around 70% of our patients. There is a strong a association between the presence of concomitant injuries and the trauma mechanism [5, 24, 25]. Head and chest inuries are common in our study. They occur in high speed RTCs when not using seatbelts . Traumatic brain injury (TBI) occurs in around 35% of facial trauma patients. Therefore, a high index of suspicion of TBI should be raised when evaluating patients with facial injuries [23, 27, 28]. Alvi et al. found that chest injury was the second most common associated injury and occurred in around 30% of facial trauma patients. Accordingly, trauma CT of the head and chest should be performed in patients with severe facial injuries .
The median length of hospital stay in our study was three days compared with 7.5 days of Mijiti et al. . Those with pan facial fractures and cranial injuries stay longer in the hospital [2-5]. The overall mortality in our study was 2.7% which is similar to others [5, 23]. The univariate analysis showed that low GCS, increased ISS, associated chest injury, and ICU admission were significantly more in those who died similar to other studies [23, 27]. Nevertheless, the logisitic regression model showed that GCC was the only significant factor predicitng death, the best threshold being below 8. This is supported by others [5, 23]. In contrast to other studies , age had no effect on mortality in our study. This can be explained by our young population because majority of expatriate workers return back to their home country when they become old.
There is a need for more injury prevention strategies in our community targeting RTCs and work-realted injuries. This includes vehicle speed monitoring, strict penalties against road traffic violations, compulsory usage of seatbelts, helmet usage by motorcyclists, and construction of cycle tracks [18, 26, 29]. Furthermore, enforcing safety in workplaces is pivotal . Labourers using machines are at risk of sustaining work-related facial trauma more than office workers.
We have to acknowledge that our study has certain limitations. First, it a retrospective study which can be affected by missing data. Second, our study did not include patients who died before arriving to the hospital or those who were treated at the Emergency Department and discharged home which has the risk of selection bias. Finally, the current study stemmed from one trauma center limiting its generalizability to the whole UAE. Nevertheless, the results provide useful information to guide strategies for counselling and injury prevention.