Objective
To use data from the National Trauma Registry of Iran (NTRI) to explore whether the type of traumatic facial fractures predicts intracranial lesions. Methods This retrospective registry-based study analyzed 6 years of data from four NTRI trauma centers, focusing on patients with facial fractures. Patients with at least one facial fracture were included, and data on demographics, injury mechanisms, fracture patterns, and intracranial lesions were analyzed. A multiple logistic regression model demonstrated the associations between clinical variables and intracranial lesions. Results Among 32,525 patients, 1,166 (3.6%) had facial fractures. Motorcycle riders had a higher probability of malar-maxillary fractures than mandibular fractures (P<0.001). Non–road traffic accident injuries were significantly associated with mandibular fractures compared to malar-maxillary fractures (P<0.001). Intracranial lesions were identified in 14.8% of patients, with subarachnoid hemorrhage (38.4%), subdural hemorrhage (19.8%), and epidural hemorrhage (18.6%) being the most common. Most intracranial lesions developed in patients with malar-maxillary fractures (n=82, 47.7%). Among the types of facial fractures, malar-maxillary fractures had the highest association with intracranial lesions (odds ratio [OR], 15.33; 95% confidence interval [CI], 6.57–35.79; P<0.001), and that finding remained significant after adjustment (adjusted OR, 7.20; 95% CI, 2.97–17.42; P<0.001). Conclusion Among patients with traumatic facial fractures, several fracture patterns were associated with intracranial lesions, with malar-maxillary fractures showing the strongest association. Careful evaluation for intracranial lesions is warranted in patients with high-risk facial fracture patterns.