top of page

Facial Fractures

> Services

Untitled.png
1-s2.0-S0733862718300993-gr1.jpg

Facial Fractures

Facial fractures refer to any break in the bones of the face, often caused by trauma such as motor vehicle accidents, falls, sports injuries, or physical assaults. These fractures can range from minor hairline cracks to severe, complex fractures involving multiple bones.

Classification of Facial Fractures

  1. Frontal Bone Fractures

    • Involve the forehead area, often resulting from high-impact trauma.

    • May affect the frontal sinus, potentially leading to complications like infection or cerebrospinal fluid (CSF) leakage.

  2. Orbital Fractures

    • Affect the bones around the eye socket.

    • Types:

      • Orbital rim fractures: Involve the edge of the orbit, often from blunt trauma.

      • Blowout fractures: Involve the orbital floor, causing herniation of orbital contents into the maxillary sinus.

  3. Nasal Fractures

    • The most common facial fractures due to the prominence of the nose.

    • Often associated with nasal septum deviation or obstruction.

  4. Zygomaticomaxillary Complex (ZMC) Fractures (Tripod Fractures)

    • Involve the zygomatic bone (cheekbone) and its articulations.

    • Typically affect the lateral orbit, zygomatic arch, and maxilla.

  5. Maxillary Fractures

    • Le Fort Fractures (classified by anatomical patterns):

      • Le Fort I: Horizontal fracture separating the maxilla from the upper teeth.

      • Le Fort II: Pyramidal fracture involving the maxilla and nasal bones.

      • Le Fort III: Craniofacial separation involving the maxilla, nasal bones, and orbits.

  6. Mandibular Fractures

    • Involve the lower jaw, frequently at weak points like the condyle, angle, or body.

    • Often associated with malocclusion (misalignment of teeth).

  7. Panfacial Fractures

    • Involve multiple regions of the face, often affecting both the upper and lower face and the midface.

Symptoms of Facial Fractures

  • Pain and Swelling: Localized to the fracture site.

  • Bruising and Ecchymosis: Often around the eyes or at the site of impact (e.g., "raccoon eyes" in basilar skull fractures).

  • Facial Deformity: Visible asymmetry or flattening (e.g., zygomatic arch fractures).

  • Epistaxis (Nosebleed): Common in nasal and maxillary fractures.

  • Visual Symptoms:

    • Diplopia (double vision) in orbital fractures.

    • Enophthalmos (sunken eyeball) or restricted eye movement.

  • Difficulty Breathing: In nasal or maxillary fractures.

  • Malocclusion: Misalignment of teeth in mandibular fractures.

  • CSF Rhinorrhea: Leakage of cerebrospinal fluid from the nose, indicating skull base involvement.

Diagnosis

  1. Clinical Examination:

    • Inspection and palpation to identify deformities, step-offs, or tenderness.

    • Assess visual acuity, pupillary reaction, and eye movements for orbital fractures.

    • Evaluate occlusion and mandibular mobility for jaw fractures.

  2. Imaging Studies:

    • X-rays: Useful for simple fractures (e.g., nasal or mandible).

    • CT Scan: The gold standard for facial fractures, providing detailed views of complex fractures.

    • MRI: May be used for soft tissue and orbital injuries.

Treatment

  1. Initial Management:

    • Airway Management: Address airway compromise, particularly in severe facial trauma.

    • Control Bleeding: Apply direct pressure to stop bleeding.

    • Pain Management: Administer analgesics.

    • Antibiotics: Prophylactic antibiotics for open fractures or sinus involvement.

  2. Definitive Treatment:

    • Closed Reduction: Non-surgical realignment of simple fractures.

    • Open Reduction and Internal Fixation (ORIF):

      • Surgical realignment and stabilization using plates and screws, commonly for complex fractures.

    • Orbital Fractures:

      • Repair with implants for blowout fractures if there is entrapment or significant deformity.

    • Mandibular Fractures:

      • Stabilization with intermaxillary fixation (IMF) or ORIF.

    • Nasal Fractures:

      • Manual realignment or rhinoplasty for cosmetic or functional correction.

Complications of Facial Fractures

  1. Acute Complications:

    • Airway obstruction.

    • Infection (e.g., sinusitis, cellulitis).

    • Hemorrhage.

  2. Chronic Complications:

    • Persistent facial deformity.

    • Malocclusion.

    • Chronic sinusitis.

    • Visual disturbances.

bottom of page