Maxillofacial trauma

1. MAXILLOFACIAL TRAUMA

2. Facial bone anatomy

4. Facial Trauma
Facial fractures are commonly caused by blunt or penetrating
trauma sustained during motor vehicle accidents, assaults,
and falls.

5. Radiographic features
Plain Radiograph
Plain x-rays are relatively insensitive to facial fractures.

6. CT-3D
Is the modality of
choice

7. The facial skeleton can be conceptualized as four
transverse and four paired vertical buttresses
The buttresses represent areas of relative increased bone thickness that
support the functional units of the face (muscles, eyes, dental occlusion,
airway) in an optimal relation and define the form of the face.
They interface with the skull base or cranium as a stable reference

8. Facial buttress pearls are as follows:
(a) The buttress concept was intended for improved
appreciation of facial structure; it does not replace
traditional anatomic terms.
(b) Buttresses have sufficient bone thickness to
accommodate metal screw fixation.
(c) Buttresses are all linked either directly or through
another buttress to the cranium or cranial base as a stable
reference point.
(d) Transverse buttress reduction restores facial profile and
width; vertical buttress reduction restores facial height.
(e) Buttress reduction establishes a functional support for
the teeth and globes.

9. The surgical treatment of displaced craniofacial fractures centers
around restoring the preinjury alignment of the skeleton by using rigid
fixation.
Preoperatively, the surgical team needs to have a thorough
understanding of the degree and nature of damage to the facial
buttresses in order to plan their exposure and restore them accurately

10. Types
Fractures which
involve a single
facial buttress:
1-frontal sinus fracture.
2-nasal bone fracture.
3-Isolated zygmoatic arch
fracture.
4-alveolar process
fracture.
5-mandibular fracture
Common complex
fractures which involve
multiple facial
buttresses:
1- Naso-orbito-ethmoid (NOE)
fracture.
2- Le Forte fracture
3- Zygomaticomaxillary complex
(Tripod) fracture

11. Frontal bone/sinus fracture

12. Nasal bone fractures

13. Orbital fractures
Orbital blow out fractures

14. Zygomatic arch fracture

15. Mandibular fractures

17. 1.Zygomaticomaxillary
complex fracture

18. 2. LE FORTE

20. Le Forte I

21. Le Forte II

22. Le Forte III

23. Naso-orbitoethmoid (NOE)
fractures involve the central
upper midface.
III. Naso-orbitoethmoid (NOE)

24. The Manson system classifies these
fractures into three major subsets
based on the medial canthus.
In type I, the fractured piece is large,
and the medial canthal insertion
around the lacrimal fossa is intact.
Accurate fixation of the large bone
fragment will restore the canthal
anatomy
In type II, there is comminution of the
buttress and the canthus is attached
to a small bone fragment.
The type III pattern cannot be
diagnosed with imaging; instead, it
needs clinical examination to
determine if the canthus is avulsed
from the bone.

27. Complex mid-facial fractures- Smash
face
Complex midfacial fractures consist of
multiple facial fractures that cannot be
classified as any of the known complex
facial fracture (e.g. Le Fort,
zygomaticomaxillary complex fracture, naso-
orbital-ethmoid fracture).