Facial Fractures

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

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  • 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.


  • 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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