Objective: The recent United States (US)-Mexico border wall height extension has been associated with greater migrant neurological and musculoskeletal morbidity after falls. However, the impact on facial trauma has yet to be characterized.

Methods: In this retrospective cohort study, patients presenting to the UC San Diego Health Trauma Center for border wall fall-related injuries between 2016 and 2021 were included. Patients were compared based on the presence of facial fractures and whether their injuries were before the height extension (2016-2018) or after (2020-2021). Demographics, clinical characteristics, concurrent injuries, and hospital charges were compared. Due to low counts of facial fractures, temporal groups were compared with Zero-Inflated Poisson (ZIP) regressions.

Results: A total of 383 patients met inclusion criteria, with 9 patients (78% male) sustaining facial fractures and 374 patients (76% male) who did not. Patients with facial fractures were younger (26 [IQR 22-27] vs. 30 years [IQR 24-39], p = 0.047), had a greater concurrence of traumatic brain injuries (22% vs. 3.2%, p = 0.039), and longer ICU length of stay (5 [IQR 2-4] vs. 3 days [IQR 4-14], p = 0.034). The post-height extension cohort had an increased rate of facial fractures (0.34 vs. 0.03 per month), multi-facial-unit fractures (50% vs. 0%), and facial injuries requiring operative intervention (38% vs. 0%).

Conclusions: Facial fractures present with greater morbidity, and the recent border wall height extension is associated with an increased risk for facial trauma. In addition to the physical trauma, facial trauma is known to harbor enduring psychological repercussions. Altogether, these injury and resource burdens pose multifaceted concerns regarding international border infrastructure.

Level of evidence: 3.

Keywords: border wall; facial fractures; facial trauma; traumatic brain injury.

© 2025 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.