OBJECTIVE: To examine the relationship between the use of restraining devices and the incidence of specific facial fractures in motor vehicle crashes. DESIGN: Retrospective analysis of patients with facial fractures following a motor vehicle crash. SETTING: University of Alabama at Birmingham Hospital level I trauma center from 1996 to 2000. PATIENTS: Of 3731 patients involved in motor vehicle crashes, a total of 497 patients were found to have facial fractures as determined by International Classification of Diseases, Ninth Revision (ICD-9) codes. Facial fractures were categorized as mandibular, orbital, zygomaticomaxillary complex (ZMC), and nasal. RESULTS: Use of seat belts alone was more effective in decreasing the chance of facial fractures in this population (from 17% to 8%) compared with the use of air bags alone (17% to 11%). The use of seat belts and air bags together decreased the incidence of facial fractures from 17% to 5%. CONCLUSIONS: Use of restraining devices in vehicles significantly reduces the chance of incurring facial fractures in a severe motor vehicle crash. However, use of air bags and seat belts does not change the pattern of facial fractures greatly except for ZMC fractures. Air bags are least effective in preventing ZMC fractures. Improving the mechanics of restraining devices might be needed to minimize facial fractures.