6. Look at the orbits carefully, 60 - 70% of all
facial fractures involve the orbit.
Exceptions: local nasal bone
fracture, zygomatic arch fracture, LeFort I
fracture.
Bilateral symmetry can be very helpful.
Carefully trace along the lines of Dolan
when examining the Waters view in a facial
series.
7.
8. Radiographic Signs of Facial Fractures
Direct Signs
nonanatomic linear lucencies
cortical defect or diastatic suture
bone fragments overlapping causing a "double-
density"
asymmetry of face
Indirect Signs
soft tissue swelling
periorbital or intracranial air
fluid in a paranasal sinus
9. Emergency Management
and Resuscitation
Airway
Most urgent complicationl: Airway compromise
Simple interventions first
No mandible?
Intubation
Avoid nasotracheal intubation
Aviod RSI
Benzodiazepines
Ketamine
Etomidate
Be Prepared and Be Creative
10. Emergency Management
and Resuscitation
Airway Management Options
Awake intubation
Fiberoptic intubation
Lateral or semi-prone position
Percutaneous transtracheal jet ventilation
Retrograde intubation
Cricothyroidotomy
11. Emergency Management
and Resuscitation
Hemorrhage Control
Rarely develop shock from facial bleeding
alone
Direct Pressure
LeFort Fractures
Nasal hemorrhage may require A&P packing
15. Maxillofacial Trauma-Physical Exam
Periorbital and Orbital Exam
Look for exophthalmos or enophthalmos
Pupil shape
Hyphema
Visual acuity
Entrapment signs
Raccoon sign
Bimanual Palpation Test
16. Maxillofacial Trauma-Physical Exam
Oral and Mandibular Exam
Mandible deviation
Teeth malocclusion
Paresthesia
Tongue Blade Test
95% Sensitive
65% Specific
18. Maxillofacial Trauma-Specific
Fractures
Orbital Fractures
Usually through floor or
medial wall
Enophthalmos
Diplopia
Infraorbital stepoff
deformity
Subcutaneous emphysema
24 % of fractures are
“Blowout fracture” the arrows
associated with ocular point to the fracture fragments and
injury periorbital tissue which have
herniated into the maxillary sinus
23. Lefort Classification
Weakest areas of midfacial complex
when assaulted from a frontal direction
at different levels (Rene’ Lefort, 1901)
Lefort I: above the level of teeth
Lefort II: at level of nasal bones
Lefort III: at orbital level
25. LeFort I
Transmaxillary fracture runs between the
maxillary floor and the orbital floor. It may
involve the medial and lateral walls of the
maxillary sinuses and invariably involves the
pterygoid processes of the sphenoid.
The floating fragment will be the lower
maxilla with the maxillary teeth
26. LeFort II
Occurs along yet another weak zone in the
face, and is sometimes called a pyramidal
fracture because of its shape.
27. LeFort III
craniofacial disassociation
large unstable (floating) fragment is virtually
the entire face!
28.
29. Mandibular Fractures
Second most common facial fracture
Often multiple
Mal-occlusion
Intra-oral lacerations
Sublingual ecchymosis
Nerve injury
Plain films
Panorex
CT
30. Clinical Findings
Facial distortion
Malocclusion of the teeth
Abnormal mobility of portions of the mandible
or teeth