The incidence of cervical spine injuries associated with facial fractures varies from study to study. The presence or absence of a cervical spine injury has important implications in trauma patients, influencing airway management techniques, choice of diagnostic imaging studies, surgical approach and timing for repair of concomitant facial fractures. There is general agreement that immediate management of cervical spine injuries is mandatory to prevent further neurological injury. Nevertheless, disagreement exists as to the actual incidence of cervical spinal trauma in conjunction with various facial fracture patterns. The purpose of this study was to review the incidence of cervical spine injury associated with various upper, middle and lower one-third facial fractures presenting to St. Michael's Hospital Regional Trauma Centre. A retrospective chart review was performed of patients presenting to the Trauma Service at St. Michael's Hospital from 1 January 1993 to 31 December 2003 inclusive. The data from this 10 year time span revealed a total of 124 patients with cervical spine injuries drawn from a cohort of 3,356 patients with craniomaxillofacial fractures. The overall incidence of cervical spine injury was 3.7%. Isolated upper 1/3 facial and skull fractures accounted for 1,711 of the patients and were associated with cervical spine injury in .53% of cases, while isolated middle 1/3 facial fractures were seen in 1,154 patients and were associated with a 1.13% rate of cervical injuries. The largest rate of association for cervical spine injury and isolated fractures was seen with lower 1/3 facial fractures at 1.51%. In contrast, combined facial fracture patterns involving two or more facial thirds accounted for the great majority of cervical spine injuries occurring at an incidence of 7.1%. The implications for trauma assessment, diagnosis and treatment of these injuries are reviewed.