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, 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

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


Pediatric Considerations
  • 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)

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Basics

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

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


Pediatric Considerations
  • 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)

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