- 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
- 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)
There's more to see -- the rest of this topic is available only to subscribers.
Schaider, Jeffrey J., 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: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307274/all/Facial_Fractures. Accessed June 9, 2023.
Facial Fractures. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307274/all/Facial_Fractures
Facial Fractures [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 June 09]. 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 - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, 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 -