What criteria should I use to determine whether to refer a patient with facial injuries to a maxillofacial surgeon?

Referral to a maxillofacial surgeon for a patient with facial injuries should be considered if there are any of the following criteria: complex facial fractures, suspected penetrating injuries, significant soft tissue damage, functional impairment such as difficulty with jaw movement or occlusion, or associated head injury with neurological signs. Additionally, any suspicion of a complex skull fracture or penetrating head injury warrants urgent referral. If there is any loss of consciousness, focal neurological deficit, or other signs of significant trauma, referral to specialist care including maxillofacial surgery is indicated. The presence of bleeding or clotting disorders, current anticoagulant therapy (except aspirin monotherapy), or safeguarding concerns also necessitate specialist assessment. Clinical judgement should guide referral when visible trauma to the head or face is concerning, or when the patient or carers express ongoing concern about the injury. Transport and referral should be arranged promptly, with communication to the receiving hospital. These criteria align with the broader head injury referral guidelines emphasizing the need for specialist assessment in complex or high-risk cases ¹.