Facial Fractures

Facial Fractures

Nasal Fracture

·        Fracture of the nasal cartilages and nasal bone are common and leave a deformity if not correctly treated 

·        If a nasal fracture is suspected, hold the patient‟s nose gently and move it slightly. Pain or abnormal movement indicates a fracture 

·        Treatment: Dislocated or displaced fractures of the nasal bones need to be repositioned accurately. Refer to ENT

 Zygoma

·        Fractured by a direct blow to the face.

·        If there is bruise over the cheekbone, check zygoma fracture

·        On inspection and palpation, the zygoma bone should be depressed

·        If untreated, depression zygoma will cause diplopia and damage to the infraorbital nerve.

·        Treatment: Fragments need repositioning.  May require fixation with wires or external fixation

Orbital Fractures

·        If direct trauma to the orbit or eye, look for orbital fracture

·        Diplopia and the abnormal position of the eye should lead to the diagnosis

·        Treatment: Surgery

Maxilla

·        Le Fort classification of maxillary fractures:

o  1:  through the maxilla, leaving nose and orbits intact

o  2:  through the maxilla, into the orbit and across the nose leaving the lateral side of the face mobile

o  3:  same as 2 but fracture extends through the lateral wall of the orbit and across the nose

·        All maxillary fractures are an emergency because the lateral wall of the face may be unstable and can fall backwards to obstruct the airway.

·        Treatment:  Secure airway.  External fixation to the skull

Mandible

·        Dislocation of the TMJ can follow direct or indirect trauma, or even a wide yawn

·        Dislocation can usually be reduced easily if the mandible is intact 

·        Can recognise a fracture by tenderness when the mandible is palpated or squeezed gently, and by a deranged dental occlusion

·        X – ray if in doubt

·        Soft tissue swelling round a fractured mandible can obstruct the airway

·        Treatment: Surgery.  May require internal fixation, interdental wiring and dental treatment