Facial Trauma

Maxillary fractures

• The maxilla forms a bridge between the cranial base and dental occlusal plane - functionally and cosmetically important structure

• Fracture of these bones is potentially life-threatening as well as disfiguiring

• Mechanism of injury: high-energy blunt force trauma to the facial skeleton

Orbital floor fractures

Clinical presentation

• Pain, decreased visual acuity, diplopia

• Hypoaethesia in infraorbial region

• Periorbital ecchymosis

• Oedema

• Enopthalmos

• Restriction of ocular movement

• Bony step of orbital rim

Investigations

• CT - 'tear drop' sign indicates blow-out fracture

Management

• Conservative

• Surgical repair of bony walls if there is entrapment, a large defect, or significant enopthlamos

Midfacial fractures

Le Fort Classification

Clinical presentation

• Soft tissue swelling

• Bruising and haematoma

• Posterior retrusion of the mid face

• Upper airway may be compromised

• Palpate - detect for bony irregularities, step-offs, crepitus, and sensory disturbances