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Facial Fractures

Facial Fractures is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Typically blunt trauma from motor vehicle accidents, direct blows including assaults, or falls.
  • 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

  • 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.

Geriatric Considerations
  • Falls most common cause.
  • Zygoma most common bone fractured.
  • Beware of associated cervical and intracranial injuries.


Pediatric Considerations
  • Maxillofacial fractures rarely seen in children younger than 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)

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Citation

Rosen, Peter, et al., editors. "Facial Fractures." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307274/all/Facial_Fractures.
Facial Fractures. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307274/all/Facial_Fractures. Accessed April 25, 2019.
Facial Fractures. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307274/all/Facial_Fractures
Facial Fractures [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307274/all/Facial_Fractures.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Facial Fractures ID - 307274 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307274/all/Facial_Fractures PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -