FRactures of face

2. Mode of injury
0 Accidents – 70% of accidents produce some type of
facial injury (most are limited to soft tissue)
0 Fights/Assaults
0 Falls
0 Sports
0 Industrial Accidents
0 Gunshot Wounds
*Less than 10% of all facial fractures occur in children

3. The face is divided into five anatomic areas :
1. nasal
2. orbital,
3. Zygomatic
4. maxillary
5. mandibular.
These regions are connected by
four vertical
four horizontal buttresses

5. Radiographic views
Three films
0 Waters view – PA view with cephalad angulation
This is the most consistently helpful view in facial
trauma
0 Caldwell view – PA view
0 Lateral view

6. Caldwell view
Caldwell's view (or
Occipitofrontal view) is a
radiographic view of skull, where
X-ray plate is angled at 15° to
orbitomeatal line. The rays pass
from behind the head and are
perpendicular to radiographic
plate. It is commonly used to get
better view of frontal sinuses.

8. The Waters (Occipitomental)
View
Waters' view (also known as the Occipitomental view) is a
radiographic view, where an X-ray beam is angled at 45° to the
orbitomeatal line. The rays pass from behind the head and are
perpendicular to the radiographic plate.

10. The Lateral View
The skull lateral view is a nonangled lateral
radiograph of the skull. This view provides an overview
of the entire skull rather than attempting to highlight
any one region.

13. PATTERNS OF FRACTURES
0 Nasal fractures:

14. 0 Naso-orbital-ethmoid fractures: Involved are the medial vertical
buttresses and the upper transverse maxillary buttress.

15. 0 Orbital fractures:

16. Posterior blowout fracture (A) The
posterior floor cortex is absent on the
left at the arrow in this CaIdwell view.
(B) In the Waters view, an abnormal
linear opacity (arrow) represents the
displaced orbital floor fragment.

17. Isolated orbital fractures:
0 Blow out fractures: due to the direct impact to the orbit by an object that is of
bigger volume than the orbit itself, which produces a fracture of the orbital floor
with displacement of the orbital content towards the maxillary sinus.

20. Zygomaticomaxillary complex fractures:
Zygomaticomaxillary complex (ZMC) fractures, also known as a tripod, tetrapod,
quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the
face. They comprise fractures of the:
0 zygomatic arch
0 inferior orbital rim, and anterior and posterior maxillary sinus walls
0 lateral orbital rim

21. Tripod
Fracture
zygomatic arch
inferior orbital rim, and anterior
and posterior maxillary sinus
walls
lateral orbital rim

22. Le Fort fracture
0 Le Fort fractures are fractures of the midface, which
collectively involve separation of all or a portion of the
midface from th skull base. In order to be separated from the
skull base the pterygoid plates of the sphenoid bone need to
be involved as these connect the midface to the sphenoid
bone dorsally. The Le Fort classification system attempts to
distinguish according to the plane of injury.

24. 0 Le Fort type 1
0 horizontal maxillary fracture, separating the teeth from the upper face
0 fracture line passes through the alveolar ridge, lateral nose and inferior wall of
maxillary sinus

25. 0 Le Fort type 2
0 pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at
its apex
0 fracture arch passes through posterior alveolar ridge, lateral walls of maxillary
sinuses, inferior orbital rim and nasal bones

26. 0 Le Fort type 3
0 craniofacial dysjunction
0 fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital
wall, and zygomatic arch / zygomaticofrontal suture

27. Thankyou

28. Types of Le Fort fracture

29. 0 Le Fort type 1
0 horizontal maxillary fracture, separating the teeth from the upper face
0 fracture line passes through the alveolar ridge, lateral nose and inferior wall of
maxillary sinus

30. 0 Le Fort type 2
0 pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at
its apex
0 fracture arch passes through posterior alveolar ridge, lateral walls of maxillary
sinuses, inferior orbital rim and nasal bones

31. 0 Le Fort type 3
0 craniofacial dysjunction
0 fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital
wall, and zygomatic arch / zygomaticofrontal suture