Background and Objective: Congenital craniofacial anomalies emerge as changes in structure, function and metabolism at birth. This study aimed to identify congenital malformations of the face and different non-healed and healed craniofacial fractures and their epidemiology in people younger than 18 years in the province of Zanjan.

Materials and Methods: This study was carried out on all urban healthcare centers and school health units in the province of Zanjan in order to evaluate all people younger than 18 years for craniofacial anomalies. In rural centers, trained health workers completed the relevant forms for all the people in their area. Later they referred patients with specific needs to Ayatollah Mousavi hospital for more evaluation. Afterwards, all individuals with facial fractures were referred to the plastic surgery clinic of the above mentioned hospital.

Results: 87,356 people were evaluated in this study. 152 children and adolescents (1.7 per thousand people) had an anomaly. 86.2% (131) of the cases referred for treatment while 13.8% did not. Of the referred cases, 49 individuals (32.2%) had not undergone surgery. There was a surgery satisfaction rate of 36% and a surgery dissatisfaction rate of 36.9% in those who had undergone surgery.

Conclusion: This study clarified that healthcare referral system has not been working properly. Among the people with facial fractures who have been referred to surgical unit, many have not undergone surgery. In general, there was a surgery satisfaction rate of 36% and a surgery dissatisfaction rate of 36.9% in those who had undergone surgery. Individuals with facial fractures had long-term problems such as trouble in speaking and listening and communicating with others.  Since the adverse effects of surgery can affect their quality of life, overcoming these problems with secondary treatment is required.