This document discusses middle third facial fractures, including their causes, characteristics, classifications, signs and symptoms, investigations, and radiographic evaluation. It covers fractures of the dentoalveolar region, zygomatic complex, orbital floor, nasal complex, and LeFort types I, II, and III. Key signs include ecchymosis, edema, step deformities, enophthalmos, diplopia, malocclusion, and nasal deformities. Investigations involve forced duction testing, imaging like occipitomental and submentovertex views to evaluate fracture patterns and displacement.

1. Middle third fractures
Dr. Mohamed Rahil
(Maxillofacial surgeon)
Tikrit dentistry college

5. Etiology
1.RTA
2. Fall from hight
3.occupational accident
4.fighting
5.Sport injury
6.War injury

6. Physical characteristics of midfacial skeleton
1.middle third consist from multiple bones
which is rarely fractured in isolation
2.this type of structures able to withstand
considerable force from below but early
fractured from other directions
3. it act as a cushion for trauma directed to the
cranium

7. Classification of mid face fractures
• Dentoalveolar fractures
• Zygomatic complex fracture
• Orbital floor fracture
• Nasal complex fracture
• Le Fort I
• Le Fort II
• Le Fort III

8. CLINICAL PRESENTATIONS

9. Dentoalveolar fractures
• Damage to the teeth
• Damage to the lip
• Alveolar fracture

10. Fracture of zygomatic ((complex))

12. Classification of zygomatic complex fracture
I . Fracture of the body
a. Minimal or no displacement
b. Inward and downward displacement
c. Inward and posterior displacement
d. Outward displacement
e. Comminution

14. II. Fracture of zygomatic arch
a. Minimal or no displacement
b. V-type fracture
c. comminuted

15. Signs and symptoms
I. Extra oral
 Inspection
a. Circumorbital ecchymosis
b. Subconjunctival heamorrhage
c. Edema
d. Flattening zygoma region
e. Limitation of ocular movement
f. Diplopia
g. Strabismus
h. Enophthalmos
i. Limitation of mouth opening
j. Unilateral epistaxis

18. Palpation
a. Tenderness over the cheek bones
b. Tenderness and separartion at frontozygomatic
suture
c. Step at inferior orbital rim
d. Parasthesia of the cheek

20. Intra oral examination
 By inspection
a. Ecchymosis at the buccal vestibule in the region
of zygomatico-maxillary suture
b. Possible of occlusion gagging in molar region
By palpation
Tenderness
Anasthesia at the upper lip

22.  Classification
a. Minimal or no displacement
b. V- shaped displacement
c. Comminuted fracture

23. Orbital floor fracture

27. Signs and symptoms
• Edema , COE , SCE , Emphysema
• Unilateral epistaxis
• Parasthesia within the
distribution of infra-orbital
nerve
• Limitation of eye movement
• Enophthalmus,diplopia,ptosis
• proptosis

28. Invesigations
• Forced duction test
• Cardinal position of the gaze
• Hess chart

29. Forced duction test:
This test use to differentiate between
Muscle entrapment and muscle paralysis

31. Radiology
a. Opacity of sinusis
b. Hanging drop sign

32. Nasal complex fracture

33. • Edema , SCH, COE ,lacerations
• Epistaxis
• Deviation of the nose
• Mobility of bone
• epiphoria
Signs and symptoms

34. LEFORT FRACTURES

37. Lefort I

38. • Clinical findings:
– Facial edema
– Malocclusion of the teeth
– Motion of the maxilla while the
nasal bridge remains stable

39. LeFort II

40. • Clinical findings:
– Marked facial edema
– Nasal flattening
– Traumatic telecanthus
– Epistaxis or CSF
rhinorrhea
– Movement of the upper
jaw and the nose.

41. LeFort III
– Fractures through:
• Maxilla
• Zygoma
• Nasal bones
• Ethmoid bones
• Base of the skull

42. LeFort III
• Clinical findings:
– Dish faced deformity
– Epistaxis and CSF rhinorrhea
– Motion of the maxilla, nasal
bones and zygoma
– Severe airway obstruction

43. CSF leak

46. Radiograph for maxillofacial trauma

47. Occipitomental view

48. Sub-mentovertex view

49. Thank you for listening