Fractures of the facial bones can occur in several areas. Nasal bone fractures are common and may require closed or open reduction depending on the displacement. Naso-orbital fractures involve multiple structures and often require CT imaging and open reduction. Zygomatic fractures can cause herniation of orbital contents and are treated with open reduction and internal fixation. Fractures of the orbital floor cause herniation of orbital fat and may require open reduction. Maxillary fractures can disrupt the occlusion and midface and are treated with interdental wiring, arch bars or open reduction depending on the location and severity of the fracture. Mandibular fractures are also treated with closed or open reduction methods like interdental wiring or direct

2. FRACTURE OF FACE

4. FRACTURE OF NASAL BONES AND
SEPTUM

6. SEPTAL FRACTURE

9. DIAGNOSIS PHYSICAL EXAMINATION
X RAY [RIGHT AND LEFT LATERAL
VIEW]

10. TREATMENT
• Simple fractures without displacement need no treatme
• others may require closed or open
reduction.
1. Closed
reduction -
• Depressed fractures of nasal bones sustained by
either frontal or lateral blow can be reduced by a
straight blunt elevator guided by digital
manipulation from outside.
2. Open
reduction • Early open reduction in nasal fractures is rarely
required.
• This is indicated when closed methods fail.

13. NASO-ORBITAL
FRACTURES
• Direct force over the nasion fractures nasal bones and displaces them
posteriorly.
• Injury may involve cribriform plate, frontal sinus, frontonasal
duct, extraocular muscles,eyeball and the lacrimal
apparatus.
Medial canthal ligament may be avulsed
CLINICAL
FEATURES
.
• Telecanthus
• Pug nose
.
• Periorbital ecchymosis
• Orbital haematoma
.
• CSF leakage

14. DIAGNOSIS Computed tomography(CT) scans are more useful.
1. Closed reduction. In uncomplicated cases, fracture is
reduced with Asch’s forceps and stabilized by a wire passed
through fractured bony fragments and septum and then tied
over the lead plates. Intranasal packing is given. Splinting is
kept for 10 days or so.
TREATMENT
2. Open reduction. This is required in cases with extensive
comminution of nasal and orbital bones, and those complicated
by other injuries to lacrimal apparatus, medial canthal
ligaments, frontal sinus, etc

15. FRACTURES OF ZYGOMA (TRIPOD FRACTURE)
• Zygoma is the second most frequently fractured bone
• Orbital contents may herniate into the maxillary
sinus.
CLINICAL FEATURES Restricted ocular movements
Oblique palpebral fissure
Trismus
Flattening of malar prominence
Periorbital emphysema

17. DIAGNOSIS
• CT scan of the orbital will be more
useful.
• Coronal and axial view
TREATMENT
• Open reduction
• Internal wire fixation
• Wire fixation is done at frontozygomatic suture and
infraorbital margin

18. FRACTURES OF ZYGOMATIC ARCH
• Zygomatic arch generally breaks into two fragments which get
depressed
• There are three fracture lines, one at each end and third in the
centre of the arch.
CLINICAL FEATURES
• Depression in the area of zygomatic arch.
• Local pain aggravated by talking and chewing,
• trismus or limitation of the movements of mandible
DIAGNOSIS • Arch fractures are best seen on
submentovertical view of the skull.

19. TREATMENT
• A vertical incision is made in the hair-bearing area
above or in front of the ear, cutting through temporal
fascia.
• An elevator is passed deep to temporal fascia and
carried under the depressed bony fragments which are
then reduced.
• Fixation is usually not required as the fragments remain

20. FRACTURES OF ORBITAL
FLOOR
• “Blow out fractures”
• Large blunt object strikes the globes,
CLINICAL FEATURES
• Ecchymosis of lid, conjunctiva and sclera.
• Enophthalmos with inferior displacement of
the eyeball.
• Diplopia.
• Hypoaesthesia or anaesthesia of cheek and
upper lip.

22. FRACTURES OF
MAXILLA
CLINICAL FEATURES :-
1. Malocclusion of teeth with anterior open bite.
2. Elongation of midface.
3. Mobility in the maxilla.
4. CSF rhinorrhoea. Cribriform plate is injured in Le
Fort II
and Le Fort III fractures

24. • Restore the airway and stop severe haemorrhage from
maxillary artery or its branches.
TREATMENT
Fixation of maxillary fractures can be achieved by:-
1. Interdental wiring.
2. Intermaxillary wiring using arch bars.
3. Open reduction and interosseous wiring as in zygomatic
fractures.
4. Wire slings from frontal bone, zygoma or infraorbital rim to
the teeth or arch bars.

25. FRACTURES OF MANDIBLE

27. Pain
Trismus
Tenderness
Malocclusion of teeth
Deviation of jaw to the opposite side on opening the
mouth.
CLINICAL FEATURE
TREATMENT
Both closed and open methods are used for reduction and fixation of the
mandibular fractures.
In closed methods, interdental wiring and intermaxillary fixation are useful.
External pin fixation can also be used.
In open methods, fracture site is exposed and fragments fixed by direct
interosseous wiring. This is further strengthened by a wire tied in a figure of
eight manner.

28. OROANTRAL FISTULA
• It is a communication between the antrum and oral cavity.
• The fistulous opening may be situated on the alveolus or gingivolabial
sulcus.
AETIOLOG
Y
• Dental extraction is the most important cause
• Failure of sublabial incision to heal after Caldwell–Luc
operation.
• Erosion of antrum by carcinoma.
• Fractures or penetrating injuries of maxilla.
• Osteitis of maxilla, syphilis or malignant granuloma.
CLINICAL
FEATURES • Regurgitation of food.
• Foul-smelling discharge.
• .
• Inability to build positive or negative pressure in
the mouth.

30. DIAGNOSIS
• A probe can be passed from the fistulous opening in the oral cavity
into the antrum.
Recent
fistula
TREATMEN
T
Suturing of gum margins and a course of antibiotics
is effective.
Chronic fistula or a large
fistula
• It requires surgical repair by a palatal or a buccal flap.
• Maxillary sinusitis is first treated by repeated irrigations and
antibiotics.
• Caldwell–Luc operation may be required to remove a retained tooth
root or a foreign body, clear the antrum of diseased mucosa and to
provide a nasoantral window for free drainage.