The COVID-19 pandemic profoundly affected trauma epidemiology, but data on post-pandemic maxillofacial trauma remain limited. This study compared midfacial fracture epidemiology between intra-pandemic and post-pandemic periods at a tertiary maxillofacial trauma center.

This retrospective cohort study included 156 adults with non-nasal midfacial fractures treated intra-pandemic (February 2020 - January 2021; n  = 57) or post-pandemic (February 2023 - January 2024; n  = 99). Demographics, trauma etiology and context, fracture patterns, associated injuries, temporal distribution, and treatment parameters were compared.

Falls (66.7 % vs. 20.2 %; q   <  0.001), accidents at home (56.1 % vs. 15.2 %; q   <  0.001), and syncope-related trauma (17.5 % vs. 5.1 %; q  = 0.034) decreased post-pandemic, whereas alcohol-associated trauma increased (10.5 % vs. 27.3 %; q  = 0.034). Differences in falls, accidents at home, and alcohol-associated trauma remained significant after adjustment for age and sex. Road-traffic, interpersonal-violence, sports, and e-scooter injuries increased numerically but none of these differences were statistically significant after FDR adjustment. The overall time-of-day distribution differed between cohorts ( p   <  0.001), with proportionally fewer morning and more evening/night injuries post-pandemic. Time to presentation and surgery decreased post-pandemic (respectively p  = 0.008, p  = 0.001), while no statistically significant differences were detected in fracture distribution or length of stay.

Post-pandemic midfacial trauma was characterized by fewer fall- and home-associated injuries and more alcohol-associated and night-time trauma, whereas no statistically significant differences were detected in fracture distribution or treatment modality. These findings suggest that the principal differences between the study periods concerned exposure circumstances and injury timing rather than anatomical fracture patterns. Given the observational design and absence of a directly analyzed pre-pandemic comparator, these findings describe differences between the two study periods without establishing a causal effect of reopening or a return to pre-pandemic patterns.