Facial and Mandibular Fractures

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Facial and Mandibular
Fractures
Presented by M.A. Kaeser, DC
Spring 2009
Basic Facial Series
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Three films
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Waters view – PA view with cephalad angulation
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This is the most consistently helpful view in facial
trauma
Caldwell view – PA view
 Lateral view
A fourth film may be warranted
Submentovertex view – through the foramen
magnum
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Simple Rules

Look at orbits carefully
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60-70% of all facial fractures involve the orbit
Know the most common patterns of facial
fractures and look for them
Bilateral symmetry can be very helpful
Carefully trace along the lines of Dolan when
examining the Waters view in a facial series
Lines of Dolan

Three anatomic contours

The 2nd and 3rd lines together form the profile of an
elephant
Direct Radiographic Signs of Facial
Fractures
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Nonanatomic linear lucencies
Cortical defect or diastatic suture
Bone fragments overlapping causing a
“double-density”
Asymmetry of face
Indirect Radiographic Signs of
Facial Fractures
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Soft tissue swelling
Periorbital or intracranial air
Fluid in a paranasal sinus
MOIs
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Auto accidents – 70% of auto accidents produce some
type of facial injury (most are limited to soft tissue)
Fights/Assaults
Falls
Sports
Industrial Accidents
Gunshot Wounds
*Less than 10% of all facial fractures occur in
children
Fracture Types and Prevalence
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Zygomaticomaxillary complex – AKA Tripod
fracture = 40%
LeFort I = 15%
LeFort II = 10%
LeFort III = 10%
Zygomatic arch = 10%
Alveolar process of maxilla = 5%
Smash Fractures = 5%
Other = 5%
Tripod Fracture

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Most common facial fracture
Usually occurs as a diastasis of the
zygomaticofrontal suture
LeFort Fractures

Complex, bilateral fracures associated with a large unstable fragment

Involve the pterygoid plates
Three Main Planes of Weakness in
the Face

Maxillary Plane
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Subzygomatic or Pyramidal Plane

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Between the maxillary floor and the orbital floor
MOI = down ward blow to the nasal area
Craniofacial Plane
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Uncommon as an isolated injury
Occurs in association with severe skull and brain
injuries
Zygomatic Arch Fracture
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Usually due to a blow from the side of the face
Cause flatness of the lateral cheek area,
inability to open mouth
Alveolar Process of Maxilla
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Associated with several fractured teeth
Chest film should be taken if all teeth are not
accounted for
Smash Fracture
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Severe comminution of the face
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Underlying skull injury is likely
Blowout Fracture
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MOI – blow to the eye, forces are transmitted by the soft tissues of the orbit
downward to the thin floor of the orbit
Symptoms – enophthalmos and diplopia (usually an upward gaze)
24% are associated with ocular injury
Nasal Bone Fracture
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Most commonly missed facial fracture
Most frequently injured facial structure
Most nasal bone fractures will run
perpendicular to the bridge of the nose
May be associated with more extensive
injuries
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Orbital rim or floor
Ethmoid or frontal sinuses
Mandibular Fractures
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Clinical findings
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Facial distortion
Malocclusion of the teeth
Abnormal mobility of portions of the mandible or
teeth
Ring Bone Rule – AKA Pretzel-Bagel
Spectrum

If you see a fracture or dislocation in a ring
bone or ring bone equivalent, look for another
fracture or dislocation
Common Sites of Mandibular
Fractures and Prevalence
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Body
Angle
Condyle
Symphysis
Ramus
Alveolar
Coronoid Process
30-40%
25-31%
15-17%
7-15%
3-9%
2-4%
1-2%
Mandibular Fractures
Mandibular Fractures
Double Mandibular Fractures
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Usually contralateral sides of the symphysis
Common combinations include:
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Angle plus the contralateral body or condyle
Mandibular Dislocation
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May occur spontaneously during a large yawn
Considerable pain
Condyle (c) is anterior to the articular eminence (e)
Important Thoughts About
Mandibular Fractures
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Remember the ring bone rule
Symphyseal fractures can be hard to see
Panorex view provides the best single view of the
mandible
Look carefully along the cortical margin of the whole
mandible for discontinuities
Carefully examine the mandibular canal for
discontinuities
Pathologic fractures can occur in the mandible – look
for tumors or abscesses
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