Facial Fractures

Description

• Typically blunt trauma from motor vehicle accidents, sports, direct blows including assaults, or falls
• Gunshot wounds are another common cause
• Consider physical assault and domestic violence, especially in women and children
• Open fractures common
• Many facial fractures are complex and are not easily classified

Etiology

• Most common are nasal bone, orbital floor, zygomatic bone, maxillary sinus
• Le Fort fractures involve the maxilla and are classified as:
  • Le Fort I: Transverse fracture of maxilla below nose but above teeth through lateral wall of maxillary sinus to lateral pterygoid plate
  • Le Fort II: Pyramidal fracture from nasal and ethmoid bones through zygomaticomaxillary suture and maxilla, often involving maxillary sinuses and infraorbital rims
  • Le Fort III: Craniofacial disjunction with elongated, flattened face owing to fractures through frontozygomatic suture, orbit, base of nose, and ethmoid bone
  • Le Fort IV: Includes frontal bone in addition to Le Fort III
  • A patient may have different level Le Fort fractures on each side of the face
• Zygomatic arch fractures often occur in 2 or 3 places and can involve the orbit and maxilla (tripod fracture)
• Inner plate frontal sinus fractures are associated with CSF leaks and ocular injuries
• Orbital fractures most commonly involve the orbital floor (blow-out fracture), and are commonly associated with ocular injuries but can involve the medial and lateral orbital walls

• Falls most common cause
• Zygoma most common bone fractured (after nasal fractures)
• Beware of associated cervical and intracranial injuries

• Maxillofacial fractures rarely seen in children <6 yr; suspect nonaccidental trauma
• Falls and motor vehicle accidents account for most cases
• Over 50% have severe associated injuries, high incidence of associated head injury
• Fractures of the orbit are the most common facial fracture in children (excluding nose)