2. 38yo M presents
unconscious after
motorcycle accident. Pt
found 40yds from
scene. Obvious facial
trauma and left lower
extremity trauma.
 T 98.6 HR 120 RR 12 PO2
90% NRB BP 95/60
 GEN:GCS 8
 HEENT: PERRLA, b/l
ecchymosis, midface
unstable, severe facial
edema, blood in
oropharynx

4. Right type III Fx
Bilateral pterygoid

5. Intubation
 GCS score plus significant facial instability
Trauma Evaluation
Ophthalmology c/s
Admit
 OR for open reduction and internal fixation
 Trauma Observation for associated injuries
 Airway Management

6. Physical Exam
 Entire face shifts including eyes and nose
Fracture Line
 Transverse
 Nasofrontal/frontomaxillary sutures->orbit floor-
>zygomatic arch
Highest Rate of CSF Rhinorrhea

7. Right: Type I
Left: Type II and III w/zygomatic
fx (arrow)
Right Type III in
pediatric patient

8.  Tintanelli’s Emergency Medicine: A Comprehensive Study
Guide. Chapter 257 Maxillofacial Trauma
http://www.urmc.rochester.edu/smd/Rad/neuroc
ases/Neurocase488.htm
 Rhea, J. How to Simplify the CT diagnosis of LeFort
Fractures.AJR, 2005.184: 1700-1705.
Alcala-Galiano. Pediatric facial fractures-children
are not small adults.RadioGraphics, 2008.28: 441461