Surreal image of a soldier's face merged with a battlefield, symbolizing military oral-maxillofacial injuries.

Hidden Wounds: Unmasking Oral-Maxillofacial Injuries in Military Personnel During Wartime

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"A deep dive into the prevalence and impact of oral-maxillofacial (OMF) injuries among U.S. military personnel in Iraq and Afghanistan from 2001 to 2014, revealing critical insights for improved healthcare strategies."

In recent years, the medical community has increasingly focused on injuries affecting the craniomaxillofacial (CMF) region, particularly among military personnel deployed in Iraq and Afghanistan. A study by Chan et al., which characterized CMF injuries over a decade during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), highlighted that these types of injuries accounted for approximately one-third of all battle injuries treated at in-theater military treatment facilities (MTFs).

Despite years of conflict, the full scope and nature of oral-maxillofacial (OMF) injuries within military armed conflicts remain only partially understood. The availability of reliable rate-based data on these injuries is limited but crucial. A 1979 study by Katz on Army personnel reported an 'accidental dentofacial' injury rate, and Mitchener et al. have contributed studies on air medical evacuations (MEDEVACs) related to OMF conditions in the early 2000s. Yet, comprehensive surveillance data concerning OMF injuries have been scarce.

To address this gap, a new study was undertaken to report detailed U.S. Department of Defense (DoD) rates of OMF injuries sustained in Iraq and Afghanistan. This investigation aims not only to define the extent of the problem, but also to enhance the descriptive epidemiology available for military OMF injuries, thereby informing public health strategies and improving medical support in conflict zones.

Key Findings on Oral-Maxillofacial Injuries in Military Operations

Surreal image of a soldier's face merged with a battlefield, symbolizing military oral-maxillofacial injuries.

The study analyzed data from military personnel who sought care at Level III military treatment facilities (MTFs) in Afghanistan (OEF), Iraq (OIF), and Operation New Dawn (OND) between October 19, 2001, and June 30, 2014. Researchers used diagnosis codes from the DoD Trauma Registry (DoDTR) to identify both battle and non-battle related oral-maxillofacial injuries. The Defense Manpower Data Center provided troop strength numbers, which served as the basis for calculating injury rates.

Key findings from Operation Enduring Freedom (OEF):

Battle injuries accounted for approximately 80% of all OMF injuries.
Out of 2,504 OMF injuries, the Army reported 1,820 cases (72.7%), followed by the Marines with 535 cases (21.3%). The Air Force and Navy each reported 75 (3.0%) and 74 (3.0%) injuries, respectively.
OMF injury rates within the Army varied from 1.10 to 4.90 per 1,000 person-years (PY). For the Marines, rates ranged from 0.57 to 9.39 per 1,000 PY. The Navy saw rates from 0 to 3.29 per 1,000 PY, and the Air Force, from 0 to 3.38 per 1,000 PY.
The Army experienced the highest incidence rates early and late in the conflict, while the Marines had the highest rates during the middle years.
Notably, 2009 marked the highest incidence for the Marines, Army, and Navy, coinciding with the troop surge from 2009 to 2011.

Key findings from Operation Iraqi Freedom and Operation New Dawn (OIF/OND):

Final Thoughts

This research underscores the critical need for continued and enhanced surveillance of OMF injuries in military theaters to inform healthcare strategies, resource allocation, and preventive measures. Ultimately, this can lead to better outcomes for service members facing the harsh realities of modern warfare.

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Everything You Need To Know

What are oral-maxillofacial injuries, and why is it important to study them in military personnel?

Oral-maxillofacial (OMF) injuries refer to injuries affecting the mouth, face, and jaws. These injuries are significant because they can impact a service member's ability to eat, speak, and breathe, affecting their overall health and quality of life. Understanding the patterns and rates of OMF injuries, particularly in conflict zones, is crucial for developing effective prevention strategies and providing timely and appropriate medical care to those who sustain these injuries.

What is the DoD Trauma Registry (DoDTR), and how was it used to collect data on injuries?

The DoD Trauma Registry (DoDTR) is a database used by the U.S. Department of Defense to record and track injuries sustained by military personnel. It's important because researchers can use diagnosis codes within the DoDTR to identify specific types of injuries, such as oral-maxillofacial (OMF) injuries, and analyze trends in injury rates. By linking this data with troop strength numbers from the Defense Manpower Data Center, researchers can calculate injury rates per person-year, providing a clearer picture of the risk of OMF injuries in different operational environments.

Where did the data come from in terms of military treatment facilities?

Level III military treatment facilities (MTFs) are medical facilities in the military healthcare system that provide a certain level of care to service members. The facilities are located in Afghanistan (OEF), Iraq (OIF), and Operation New Dawn (OND). Analyzing data from Level III MTFs allowed researchers to capture a significant portion of the OMF injuries sustained by military personnel in these areas. This provides important data for understanding the prevalence and nature of these injuries during different military operations.

What were Operation Enduring Freedom and Operation Iraqi Freedom, and why are they relevant to understanding these injuries?

Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) were major U.S. military operations in Afghanistan and Iraq, respectively. The study covers the period from 2001 to 2014, which includes the peak years of these operations. By analyzing oral-maxillofacial (OMF) injury data from these specific operations, researchers were able to identify trends and patterns related to the types and rates of injuries sustained in these distinct combat environments. This information is vital for tailoring medical support and prevention strategies to the specific challenges of different operational theaters.

What does 'per 1,000 person-years' mean, and why is this measurement important when examining injury rates?

The term 'person-years' (PY) refers to the total number of years of military service contributed by the personnel in the study. OMF injury rates are calculated per 1,000 person-years, providing a standardized way to compare injury rates across different branches of the military and different time periods. This measure accounts for variations in troop deployments and allows for a more accurate assessment of the risk of OMF injuries. For instance, the study found that OMF injury rates in the Army varied from 1.10 to 4.90 per 1,000 person-years during Operation Enduring Freedom.