Background Craniomaxillofacial trauma (CMF) represents a significant problem in the United States, with estimated costs amounting to nearly one billion dollars annually. Facial fractures occur based on factors such as facial structure, the direction and intensity of the impact, and the mechanism of injury. The most common facial fractures include the nose, the orbits, the zygomatic complex, the mandible, the maxilla, and the frontal bone. In addition, demographic, social, cultural and environmental factors can influence specific trauma mechanisms, such as falls and traffic accidents, generating different rates of CMF injuries among populations. In general, CMF trauma carries a significant potential for morbidity and mortality. This study aims to provide the first approximation of the prevalence of CMF trauma in Puerto Rico. MethodsThis retrospective study includes patients aged 0 to 100 years who presented CMF trauma between 2018 and 2022 in the only trauma center in Puerto Rico. Demographic and clinical data were collected, including the mechanism of injury, affected craniofacial structures, treatment and outcomes. Data frequencies were documented and statistical analysis was performed using one-factor ANOVA and T-tests. Results 1,102 patients with CMF lesions were included, of whom 83.1% were men and 16.4% women, with a mean age of 40.67 years. The most common mechanisms were non-automobile traffic accidents (23.6%), motor vehicle accidents (22.9%), hits (18.4%), falls (15.9%) and firearm injuries (10.4%). 32.7% of patients had cranial fractures in the following regions: temporal (16.2%), frontal (10.6%), parietal (7.8%) and occipital (5.3%). Facial fractures affected 70% of patients, distributed in: middle face, including maxilla, nose, zygoma and orbits (61.8%); lower side, including mandible (17.7%); and upper side, including frontal bone (9%). Approximately 19.8% of patients with CMF fractures required surgical management. The mortality rate was 11.8%. The Glasgow Coma Scale (GCS) and the Injury Severity Score (ISS) were significantly worse in patients with cranial (p < 0.001) and/or facial (p < 0.001) fractures compared to those who suffered CMF trauma without fractures. Conclusion To our knowledge, this is the first study to characterize CMF trauma in Puerto Rico. The majority of affected patients were adult men. Common etiologies of injury align with those reported in the literature, including traffic accidents, falls, and firearm injuries. Facial fractures were more prevalent than cranial fractures in our cohort. Patients with highly serious injuries were more likely to be operated surgically. By establishing the epidemiological landscape of CMF trauma in Puerto Rico, public and clinical health efforts can be implemented to improve patient outcomes.