FACIOMAXILLARY

INJURIES

SHEETAL H AIRANI
3 RD M B B S
HIMS,HASSAN
 Learning Objectives

 To be able to recognize life threatening nature of

facial injuries – Airway obstruction, associated head
& spinal injuries.
 Method of examining facial injuries
 Classification of facial fractures
 Diagnosis & principles of management of facial
injuries
 To appreciate the importance of careful cleaning &
accurate suturing of facial lacerations.
 Causes

 Sporting activities

 Road traffic accidents

 Intentional violence
 Clinical effects

 Injuries to facial skeleton →

1.Immediate airway obstruction

2.delayed airway obstruction

 Immediate airway obstruction

 inhalation of tooth fragments

 accumulation of blood & secretions

 loss of control of tongue in unconscious/

semiconscious pt. → Nurse in semi prone position
 delayed airway obstruction

 edema of tongue

 pharyngeal structures
 Examination of the patient

 spinal & head injuries - Edema of face makes routine

examination of face & head injuries observations
difficult.

 Lacerations should be explored and cleansed,

 Whole head should be checked- occiput, mastoid

 Examination of the patient

 Facial asymmetry & displacements examined from

the front

 Gentle palpation wearing sterile gloves over the face

& inside the mouth will detect step deformities, bone
fragments

 Middle third fracture → Epistaxis

 Examination of the patient

 Le Fort II & III fracture may be associated with CSF

rhinorrhoea

 Zygoma fracture → subconjunctival hemorrhage

 Cranial nerves
 Radiology

 Posteroanterior occipitomental (OM) radiograph

taken at 150 – 300 → suitable to illustrate the
displacement of middle1/3 fracture

 A panoramic oral radiograph(orthopanto mogram)

Fig-Rotational tomograph showing a right mandibular body fracture
Fig – Posterioanterior
(PA) mandible
showing the same
mandibular body
fracture
Coronal & Axial CT scan
 Fractures Facial Skeleton

 Upper third – above the eyebrows – involves frontal

sinuses & supraorbital ridges

 Middle third – above the mouth Le Fort I , II , II

 Lower third -- Mandible

 Middle 1/3 rd Fractures

1.Le Fort I Fracture

2.Le Fort II Fracture

3.Le Fort III Fracture

 Le Fort I Fracture

 Le Fort I fracture

Separates the alveolus and palate from the facial

skeleton above. fracture line runs from the nasal
pyriform aperture → lateral &medial walls of max.
antrum →posteriorly to include the lower part of the
pterygoid plates
 Diagnosis

 suggested by the malocclusion

 mobility of the fractured segment by doing digital

manipulation of the incisor teeth region
 Treatment

 closed reduction with inter maxillary fixation

 open reduction.

 Open reduction – intra osseous wiring - by using

small plates
 Le Fort II Fracture

 Pyramidal in shape
 Runs through the bridge of the nose & ethmoids→
medial part of the infraorbital rim & infraorbital
foramen → posteriorly through the lat wall of the
max. antrum at a higher level than Le F.I to the
pterygoid plates at the back
 Cribriform plate may be fractured > CSF
rhinorhhoea
 Treatment – Reduction of the maxilla& internal
fixation of the fragments
 Le Fort III Fracture

 Effectively separates facial skeleton from the base of

the skull

 Fracture → nasal bridge, septum & ethmoids

→irregularly through the bones of orbit →
frontozygomatic suture → lateral wall of the max.
sinus at a higher level & the pterygoid plates

 Crbriform plate →CSF rhinorhoea

 Clinical features & management

 Clinical features – facial elongation, massive facial

edema & mobility entire middle third of the face.

 Treatment – Internal fixation by a craniofacial

approach
Le Fort fractures seldom confine
to exactly to the original
classification & combinations of
any of the fracture s may occur.
 Zygomatic complex

 Fractures occur through points of weakness – the

infra orbital margin, frontozygomatic suture,
zygomatic arch, and ant. &lat. walls of the max.
sinus.

 Tears of antral mucosa → epistaxis

 Injury to infraorbital nerve → parasthesia

 Zygomatic complex

 If the floor of the orbit is disrupted , orbital contents

prolapse into the max. antrum → entrapment of the
inferior oblique & inferior rectus → diplopia

 Medial displacement of the arch impinches on the

coronoid process → difficulty in opening the jaw

 O/E – swelling of both upper & lower eyelid with

subconjuntival hemorrhage(post. Limit cannot be
seen)
 Zygomatic complex

 Complications – flat cheek,

enophthalmos,infraorbital anesthesia , restriction of
jaw opening.

 The fracture is visualized by a 300 occiptomental

view.

 Treatment – open reduction & internal fixation

 Lower 1/3 of the face

 Sites of Mandible fracture

1. Neck of the condyle

2. Angle of the mouth> last molar tooth

3. Anterior to the mental foramen > canine tooth

 Fracture Mandible

 Guardsman fracture –

 Blow to the chin →

fracture symphysis or parasymphysis
unilateral or bilateral condylar fracture (Indirect
transmission of kinetic energy)
 Clinical Features

 pain on moving the jaw

 malocclusion, lacerations

 ecchymosis of the floor of the mouth.

 Palpation – fracture line, false motion

 Fracture Mandible

Management:
 Compound fracture - broad spectrum antibiotics

 Intermaxillary fixation (IMF)

 Open reduction & internal fixation with stainless

steel / titanium plates
 Soft tissue injuries of the face

 Facial soft tissues have an excellent blood supply→

heals well
 Suturing at the earliest after debridement under
local anesthesia /GA
 Replace tissues accurately esp. vermilion border
 Hemostasis essential. Muscles & underlying tissues
should be sutured with absorbable suture materials.
Fine monofilament sutures to be used . Alt. sutures
to be removed on th3rd day, the remaining on the
5th day
THANK YOU