<p>Maxillofacial trauma frequently results from high-energy mechanisms that concurrently affect multiple body regions. While extremity injuries represent common concomitant injuries, their frequency and determinants remain inadequately characterized in Pakistani populations. This study aimed to determine the frequency, causes, and associated factors of upper and lower extremity injuries in patients presenting with maxillofacial trauma to a major tertiary care center in Peshawar, Pakistan.A hospital-based cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Lady Reading Hospital, Peshawar, over six months (January–June 2024). A total of 227 patients aged 18–65 years with maxillofacial trauma and clinical indications of extremity injury were enrolled using consecutive non-probability sampling. Upper and lower extremity injuries were defined based on standardized physical examination findings. Data on demographics, injury mechanism, maxillofacial fracture pattern, and extremity injury status were collected using a structured proforma. Statistical analysis was performed using SPSS version 21.0. Normality was assessed using the Shapiro–Wilk test. Frequencies and percentages were calculated for categorical variables, and mean ± standard deviation or median (interquartile range) for continuous variables. Stratification and chi-square/Fisher’s exact tests were applied to identify associations, with <i>p</i> &lt; 0.05 considered statistically significant.The cohort comprised 188 males (82.8%) and 39 females (17.2%), with a mean age of 32.8 ± 11.4 years. Road traffic accidents (RTAs) were the predominant etiology (69.6%), followed by falls (16.7%), assault (9.3%), and other causes (4.4%). Motorcycle accidents accounted for 65.8% of RTAs. Mandibular fractures were the most common maxillofacial injury (43.2%), followed by zygomatic maxillary complex fractures (26.9%), isolated midface fractures (17.2%), and panfacial fractures (12.8%). Concomitant extremity injuries were identified in 81 patients (35.7%). Upper extremity injuries occurred in 49 patients (21.6%), lower extremity injuries in 40 patients (17.6%), and combined upper and lower extremity injuries in 8 patients (3.5%). RTAs were associated with the highest extremity injury frequency (42.4%), followed by falls (26.3%), assault (14.3%), and other causes (10.0%) (<i>p</i> = 0.006). Stratified analysis revealed significant associations between extremity injuries and age 18–30 years (42.9%, <i>p</i> = 0.044), underweight BMI (48.4%, <i>p</i> = 0.034), employment (41.7%, <i>p</i> = 0.016), rural residence (39.1%, <i>p</i> = 0.040), panfacial fractures (62.1%, <i>p</i> &lt; 0.001), and RTA mechanism (42.4%, <i>p</i> = 0.006). Mandibular fractures demonstrated moderate extremity injury association (39.8%), while isolated midface fractures showed the lowest (17.9%).Concomitant extremity injuries occur in over one-third of patients presenting with maxillofacial trauma in this Pakistani cohort, with RTAs—particularly motorcycle accidents—constituting the predominant mechanism. Young age, underweight BMI, employment, rural residence, panfacial fracture pattern, and RTA etiology are significant predictors of extremity involvement. These findings mandate systematic extremity examination in all maxillofacial trauma patients, support integrated multispecialty trauma care pathways, and underscore the urgent need for targeted road safety interventions in Pakistan.</p>