Injury Patterns in Soccer-Induced Maxillofacial Fractures and Ocular Trauma: A Narrative Review.

Abstract

Background: Maxillofacial fractures and ocular trauma are significant injuries in soccer, with potential functional, aesthetic, and visual consequences if unrecognized. Few reviews have specifically examined both injury patterns in this sport. The purpose of this narrative review is to synthesize the current literature to identify injury patterns associated with maxillofacial fractures and ocular trauma in soccer, thereby aiding clinicians in timely diagnosis and management. Given the heterogeneity and limited quality of the available evidence, this review also highlights areas where further research is needed.

Main body: The zygoma was the most commonly fractured maxillofacial bone in soccer (32.8%), followed by the nasal (28.4%), mandibular (25.8%), orbital (6.5%), maxillary (3.6%), and frontal sinus (2.8%) regions. Among mandibular fractures, the angle was the most vulnerable site, accounting for 39.2% of cases. Head-to-head contact was the most frequent mechanism resulting in injury; however, although less common, arm or elbow impacts were more likely to result in fracture when they occurred. Ocular injuries most often present as orbital or eyelid contusions and lacerations (37.1%) and hyphemas (19.5%), with direct ball impact as the primary cause. Boys (60.4%-69.5%) were at greater risk than girls for ball sport-related ocular trauma, particularly those aged 2-9 years, with soccer being the leading sport implicated. Overall, these trends are based largely on small case series, reflecting the low quality of available evidence.

Conclusions: The zygoma is the most frequently fractured maxillofacial bone, typically resulting from head-to-head collisions. Direct soccer ball impact accounts for most ocular injuries in this sport, with orbital or eyelid contusions and lacerations most common, followed by hyphemas. Pediatric players may be particularly susceptible to soccer-related ocular trauma, possibly due to an underdeveloped orbital rim. Fundoscopic examination is essential after ball impact to detect vitreoretinal injury, even when visual acuity is normal. Further well-designed studies are needed to confirm these findings.