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Background: A multicenter, retrospective study was conducted to determine the frequency and distribution of craniofacial fractures sustained from all terrain vehicle (ATV) accidents., Methods: Medical records of all patients presenting to 2 trauma centers with ATV-related craniofacial trauma from 2001 to 2013 were reviewed. Patient notes and radiographic images were analyzed for detailed craniofacial injury data. The identified fractures were classified as: frontal/skullbase, naso-orbital, maxilla/zygoma, and mandible. In addition, patient demographic information, length of stay, airway status, intensive care unit stay, Glasgow coma scale, use of safety equipment, associated traumatic brain injury, and surgical intervention were compiled., Results: One hundred fifty-six patients with craniofacial fractures secondary to ATV accidents presented from 2001 to 2013. The incidence of craniofacial fractures found in patients with ATV injuries was 12.2%. Sixty-one patients (39.1%) suffered frontal/skullbase fractures, 98 (62.8%) naso-orbital fractures, 62 (39.7%) maxillary/zygoma fractures, and 35 (22.4%) mandibular fractures. Forty-one patients (26.3%) required surgical intervention to correct their craniofacial injuries., Conclusions: The most common craniofacial fractures experienced in ATV injuries are naso-orbital fractures. The correlation of nonuse of safety equipment and associated traumatic brain injuries displays the importance of using helmets when operating ATVs. Future studies can be conducted examining ATV-related upper extremity injuries, among others.