A 38-year-old man was found unconscious 40 yards from the scene of a motorcycle accident. He had obvious facial trauma including a midface fracture, severe facial edema, and blood in his oropharynx. His vital signs included a temperature of 98.6 F, heart rate of 120, respiratory rate of 12, and oxygen saturation of 90% on a nasal cannula with a blood pressure of 95/60. His Glasgow Coma Scale was 8. Imaging showed right type III and bilateral pterygoid fractures. He required intubation, ophthalmology consultation, and admission to the operating room for open reduction and internal fixation of his facial fractures.

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