The authors assessed the rate of craniomaxillofacial fractures in soccer and the areas where they occur, describing above all the injury pattern of this sport. Over a 5-year period (1995-2000) 46 cases of 329 with fractures associated with different sports activities have been surgically operated at the maxillofacial surgery department of the Policlinico "Umberto I" Hospital, University "La Sapienza" of Rome. All data collected have been selected on the basis of sex, age, anatomic site of the fracture, and the practiced sport. Information on injury patterns, severity, and play circumstances have been documented. The department examined 7 sports disciplines, but soccer was responsible for sports-related maxillofacial fractures in 34 of 46 cases (73.9%). All 34 fractures occurred to men. In soccer, the zygomatic and nasal regions are mainly involved. In fact the authors examined zygomatic fractures in 15 cases and nasal fractures in 10 cases. Direct contact between players generally causes soccer-related maxillofacial fractures: head-elbow impacts (21 cases) or head-head impacts (14 cases). The male:female ratio is 6.6:1, while the average age is 25 years for males and 23 years for females. In comparison with other sports (rugby, football, etc.) where physical contact occurs more frequently and the higher incidence of traumatic events justifies the use of protective measures, soccer is not a particularly violent sport. In soccer, maxillofacial traumas are caused by violent impacts between players that take place mainly when the ball is played with the forehead. In this moment there can be an elbow-head impact or a head-head impact. The authors believe that the low incidence of fractures, severity of the lesions, and discomfort caused by possible protective masks make their use unjustified. The data collected during this study witness that in soccer 21 of 34 cases of maxillofacial fractures are caused by elbow-head impacts. This fact suggests a preventive strategy against violent behavior in soccer play. Because the use of any sort of helmet proved impossible, the introduction of more severe penalties and a greater respect for the rules of the game by the players could reduce the percentage of impacts during matches. Impacts cause the most serious and frequent lesions in the maxillofacial region.