SA2 - Craniomaxillofacial Injury Patterns at a Level I Trauma Center: A Wartime Trauma Review of Emergency Admissions During the October 7th War

Abstract: Since the onset of the October 7th war, attacks from the Northern, Eastern, and Southern borders have resulted in injuries across the military and civilian spectrum, impacting all sectors of society. Due to sudden militarization and threat of large-scale attacks, Rambam Healthcare Campus was tranformed overnight into the world's largest underground emergency fortification center. A notable surge of severe trauma cases, particularly involving craniomaxillofacial (CMF) injuries was observed. Of those admitted to Rambam’s emergency department, many required multidisciplinary surgical team management and numerous surgical interventions, both immediate and late-stage, for definitive treatment.
A retrospective review was conducted at Rambam Healthcare Campus in Haifa, Israel analyzing trauma admissions since October 7, 2023, until February 2025. Data from over 250 emergency room (ER) logs, surgical records, and patient demographics were collected, with a focus on 20 patients presenting with complicated CMF injuries. The severity and pattern of injuries were recorded, along with surgical teams involved, and surgical codes applied throughout hospitalization. Several prominent cases involving multidisciplinary team management were the main focus to determine timeline of interventions, treatment modalities, and overall patient recovery.
The analysis revealed a substantial percentage of CMF involvement, approximately 10% of civilian admissions and over 17% in soldier admissions, and a notably high incidence of complex, multi-system injuries. Particularly complex soft tissue damage, facial shrapnel wounds, and significant blast injuries were observed and treatment protocols described. A significant challenge faced by the OMS team was the increasing volume of cases and comminuted fracture patterns, requiring triage adaptations and prioritization of surgeries with limited resources in a sub-optimal treatment setting. 3D planning served as an important tool for surgical planning and PSI/reconstruction planning in particularly comminuted fractures. Early intervention and multidisciplinary collaboration further helped improve treatment success and patient satisfaction.
The ongoing conflict in the Middle East has led to a dramatic rise in CMF injuries and need for emergency measures, placing unprecedented pressure on Rambam Healthcare Campus’ OMS team. This study presents a selection of complex CMF injuries treated and highlights the importance of preparedness, resource allocation, and team coordination in the management of trauma cases under wartime conditions. We hope that our experiences will provide insight for improved trauma protocols and surgical interventions, ensuring that healthcare systems can continue providing exceptional treatment even in times of crisis.

References:
1. El-Hai, L. (2024, September 22). Rambam Health Care Campus becomes world’s largest underground hospital. ynetnews. https://www.ynetnews.com/health_science/article/hyqyrptpr
2. Palyvoda R, Olexandr K, Yan V, Igor F, Myron U, Yurii C, Johanna S, Alla S, Andrii K, Danilo K. Maxillofacial Surgery in Ukraine During a War: Challenges and Perspectives-A National Survey. Mil Med. 2024 Aug 30;189(9-10):1968-1975. doi: 10.1093/milmed/usad465. Erratum in: Mil Med. 2024 Aug 30;189(9-10):e2290. doi: 10.1093/milmed/usae119. PMID: 38141258.
Real time segmentation of comminuted fracture to aid surgical planning and reconstruction 3D preoperative planning creating PSI and repositioning coronoid fragment in zygomatic arch In less than 24 hours, Rambam was transferred to the underground fortified hospital