Frequency and patterns of craniomaxillofacial surgery during and after COVID-19: analysis of the Japanese national database

PURPOSE: Craniomaxillofacial (CMF) trauma is primarily associated with high-energy injuries and constitutes a significant proportion of hospital presentations in Japan. The coronavirus disease 2019 (COVID-19) pandemic and related public health restrictions profoundly altered daily life and social behavior, potentially influencing trauma patterns and surgical interventions for CMF injuries. METHODS: We retrospectively analyzed nationwide data from the Japanese National Database, covering the period from 1 January 2014 to 31 December 2023. Inpatient and outpatient CMF surgical procedures were identified using procedural codes and categorized into pre-pandemic (2014–2019), pandemic (2020–2021), and post-pandemic recovery (2022–2023) periods. Statistical analysis included descriptive evaluation and comparative analysis across these periods. RESULTS: In total, 30,398 CMF surgical procedures were recorded during the 10-year study period. The pre-pandemic period averaged 3,528.0 cases per year, which declined to 2,756.5 cases per year during the pandemic period, representing a 21.87% reduction (p < 0.001). The post-pandemic period showed partial recovery, averaging 3,358.5 cases per year, remaining 4.80% below pre-pandemic levels. The largest pandemic-period declines were observed for bilateral mandibular condylar fracture surgery (− 100%), bilateral mandibular fracture surgery (− 40.5%), and non-invasive reduction of maxillary fractures (− 43.8%). Notable recovery patterns emerged post-pandemic, with zygomatic fracture procedures surpassing pre-pandemic levels (+ 2.7%), while most other procedures remained below baseline. CONCLUSION: The COVID-19 pandemic significantly reduced CMF surgical procedures in Japan, with differential impacts across procedure types. The post-pandemic period reveals heterogeneous recovery patterns—some procedures exceeding pre-pandemic levels while others persistently lag—suggesting enduring changes in trauma patterns and healthcare utilization.