Facial trauma in motorcyclists and helmet use


The benefits of helmet wearing to prevent head injury and reduce the severity of injury and mortality in motorcyclists has been consistently demonstrated and is mandatory in many places. Both full face and open-faced helmets are available and facial trauma may be more frequent in open-faced designs.

The aim of this review was to determine whether helmet use and the type of helmet reduce the occurrence and severity of facial fractures in hospitalised victims of motorcycle accidents.


Searches were conducted in the Medline/PubMed, Latin American and Caribbean Health Sciences Literature Database (LILACS), Cochrane Library, Embase, Web of Science, Scopus, ScienceDirect, BBO, SciELO and OpenGrey databases with no language or date restrictions. Prevalence, cross-sectional, cohort, prospective and retrospective studies were considered.  Prevalence of facial fractures measured using one of 3 scales Injury Severity Scale (ISS), Abbreviated Injury Scale (AIS), or Facial Injury Severity Scale (FISS) was the main outcome measure. Two reviewers independently selected studies, extracted data and assessed study quality using checklists from the Joanna Briggs Institute. Random effects meta-analyses were conducted.


  • 26 cross-sectional studies involving 68,594 patients were included.
  • 6% of patients were male with an average age of 30.7 years.
  • (OR) = 0.32(95%CI; 0.17 to 0.62) [22 studies].
  • Significantly fewer fractures of the upper face and midface were seen in helmet wearers but not in the lower face [16 studies].
    • Upper face OR = 0.43 (95%CI; 0.24 to 0.78).
    • Mid face OR = 0.70 (95%CI; 0.50 to 0.97).
    • Lower face OR = 1.15 (95%CI; 0.69 to 1.91).
  • A lower injury severity score was obtained with all scales when the patients used a helmet.
  • No differences in the occurrence of fractures or severity of facial trauma) was observed between the two types of helmet (open face and full face).


The authors concluded: –

the use of a helmet leads to a lower number of fractures and severity of trauma when compared to non-use. Regarding the type of helmet, there was no difference in the occurrence and severity of facial fracture in individuals who used closed or opened helmets.


The 2008 Cochrane review by Liu et al showed that ‘helmets are effective in reducing head injuries in motorcyclists who crash by 69% and death by 42%’. They also stated that there was no conclusive evidence on the effects of helmets on facial injuries. Most of the studies included in this new review were published after 2008 and an assessment of the impact of helmet wearing on facial fractures was possible.  The findings indicating that there were significant fewer upper and mid face fractures in helmet wearers although not for the lower face. However, while the authors reported no differences between full face and open-faced only 8 of the 26 included studies reported on this.  In relation to the severity of trauma again only 8 studies reported on this.  In the discussion the authors mention a number of potential confounders including fixation status of helmet, power and speed of the motorcycle at the time of accident as well as alcohol or psychoactive substance use.


Primary Paper

Cavalcante DKF, Veloso SRM, Durão MA, Melo VC, Monteiro GQM, Porto GG. Do Helmet Use and Type Influence Facial Trauma Occurrence and Severity in Motorcyclists? A Systematic Review and Meta-analysis. J Oral Maxillofac Surg. 2021 Feb 24:S0278-2391(21)00204-4. doi: 10.1016/j.joms.2021.02.028. Epub ahead of print. PMID: 33762165.

Review protocol on PROSPERO

Other references

Liu BC, Ivers R, Norton R, Boufous S, Blows S, Lo SK. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004333. doi: 10.1002/14651858.CD004333.pub3. PMID: 18254047.

Dental Elf -15th Jun 2018

Bicycle helmets and facial injuries

Picture Credits

Photo by Harley-Davidson on Unsplash



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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