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Maxillofacial Trauma
Joy P. Ambos, MD, DPBO-HNS
030910
Anatomy
Infraorbital ecchymosis
Swelling
Crepitus
TREATMENT

Closed reduction of nasal bone fracture
To obtain adequate airway
To restore the original appeareance
MANDIBULAR FRACTURE


The second most common fracture in the head and neck
May result from:
Vehicular accidents
Assaults
Work related
Fall
Sporting accidents
Miscellaneous
CLINICAL FINDINGS

Trismus (reduced jaw mobility)

Malocclusion

Anterior open bite deformity

Intraoral edema

Ecchymosis

Gingival bleeding

Tears

Mobility and crepitus along the symphysis, angles or body
NASAL BONE FRACTURE


The most common fracture of the maxillofacial complex
Commonly results from:
Fights (34%)
Accidents (28%)
Sports (23%)
Fall (most common cause in children)
IMAGING STUDIES

Standard Mandibular Radiographs
Posteroanterior (PA)
Mandibular view
Lateral oblique radiographs
Revers Towne’s view

Panorex View

CT Scan
CLINICAL FINDINGS
Nose deformity
Nose bleeding
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
Panoramic View
TREATMENT

There is no need to consider the correction of a mandibular
fracture an emergency

Timing of the repair must be individualized according to the myriad
factors for each patient

Stabilize the mandibular fragments with the use of an elastic
dressing placed about the mandible and around the top of the
head
Reduction of tripod fracture via Caldwell luc approach with
ballooning and external traction using the catheter for anchorage,
support and drainage
Techniques to Elevate Fractures of the Zygomatic Arch:
1. Gills Incision
2. Lateral Orbital approach
3. Intraoral (Keene) Incision
BLOWOUT FRACTURE
TECHNIQUES IN CLOSED REDUCTION AND FIXATION OF MANDIBULAR
FRACTURE

Use of Erich arch bars

Use of wires without arch bars (e.g. ivy loops, Risdon wires)

Use of dental splints

Use of dentures
TECHNIQUES FOR OPEN REDUCTION AND INTERNAL FIXATION OF
MANDIBULAR FRACTURES

Use of metal plates with screws

Use of interosseous wiring
ZYGOMATIC FRACTURE



Occur more common in males (80%) than in females (20%)
Incidence peaks in persons aged 20-30 years
May result from:
Personal altercations
Falls
Motor vehicle accidents
Sport injuries
3 main fracture sites:
Frotozygomatic suture line
Face of the maxilla
Zygomatic arch
CLINICAL FINDINGS

Ecchymosis of the cheek and eyelids

Edema

Trismus

Subcutaneous emphysema

Malar flattening and palpable periorbital step-offs

Anesthesia or parasthesia of the cheek, nose, upper lip, and lower
eyelid
Blunt trauma to the orbit
↓
Increased intraorbital pressure
↓
Orbital fat and muscle driven through the fracture in the bony floor of
the orbit
↓
Orbital contents hanging into the maxillary sinus
CLINICAL FINDINGS

Signs of diplopia

Inability to move the eyeball on upward gaze

Enophthalmos with drooping of the upper lid

Nosebleeding
IMAGING STUDIES

CT Scan of PNS and Orbits (coronal and axial views)

Skull xrays
Water’s view upright
Skull APL view
TREATMENT
Surgical exploration using either an orbital or a transantral approach
MAXILLARY FRACTURES
IMAGING STUDIES

Water’s view

Submentovertical view

CT Scan
VERTICAL BUTTRESSES

Nasomaxillary

Zygomaticomaxillary

Pterygomaxillary
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HORIZONTAL BUTTRESSES

Frontal bar

Inferior orbital rims

Maxillary alveolus and palate

Zygomatic process of the temporal bone

Serrated edge of the greater wing of the sphenoid bone

Submental vertex
CT Scan- axial and coronal views
MAXILLARY FRACTURES

Account for ~6-25% of all facial fractures

Usually result from severe, direct trauma

Blow with the fist

Fall

Automobile accident
LE FORT I
A transverse fracture above the level of the apexes of the teeth (alveolar
fracture)
Water’s view
LE FORT II
Triangular fracture that includes the nasal bone but excludes the zygoma
TREATMENT

Surgical repair
LE FORT III

Craniofacial dysfunction

Includes the separation of the maxilla, nasal bones and zygoma
from the cranium
Le Fort I fracture

Alveolus reattached to the fixed facial structures superiorly

Internal wiring, dentures, or plating
Le Fort II fracture

Wiring or plating of the infraorbital rim, maxilla

Stabilization of the nose

Interdental fixation to stabilize the maxilla
Le Fort III fracture

Zygoma suspended from the frontal bones by wiring or plating into
position

Alveolar segment supported by fixation to the cranium by
suspension wires or plates
CLINICAL FINDINGS

Edema

Elongated face

Malocclusion

Ecchymosis of the cheeks and eyelids

Palpable periorbital step-offs

(+) drawer ‘s test
IMAGING STUDIES

Standard Sinus Films
Water’s view (upright)
Caldwell view
Lateral view
COMPLICATIONS

Malocclusion- no adequate apposition between lower and upper
dental arches

Malunion- bone heals in incorrect position

Enophthalmos, exophthalmos, hypothalmos

Non-union- common in mandible, fracture fragments are mobile

Scarring

Lower lid malpositions- entropion, ectropion

Brain and ocular injuries
´The heart dies a slow death, shedding each hope like leaves, until one day
there are none.´
hgt
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