Facial injuries

Question 1

Assessment of orbital or orbitozygomatic fractures

Answer 1

Visual acuity
Pupillary light reflexes
Ocular movements
Assess for diplopia
Infra-orbital nerve numbness
Impaired jaw opening

Do not blow nose or fly for 2 weeks

Question 2

Le fort I

Answer 2

Floating palate
Pterygoid plate fracture
HORIZONTAL maxillary facial fracture, separating teeth from upper face
Fracture line passes through alveolar ridge, lateral nose and inferior wall of maxillary sinus

Swollen upper lip, bite malocclusion, maxilla mobility

Question 3

Le fort II

Answer 3

Floating maxilla
Pterygoid plate fracture
PYRAMIDAL fracture - teeth at base, nasofrontal suture at apex
Fracture line passes through posterior alveolar ridge, lateral maxillary sinuses, inferior orbital rim and nasal bones

Racoon eyes, CSF leak possible, combined maxilla and nose mobility, bite malocclusion, widened intercanthal space, infraorbital sensory deficit

Question 4

Le fort III

Answer 4

Floating face
TRANSVERSE fracture through nasofrontal suture, maxillofrontal suture, orbital walls and zygomatic arch or zygomaticofrontal suture

Raccoon eyes, ecchymosis of maxillary vestibule, lengthening and flattening of face, orbital hooding, enophthalmos, Battle’s sign, CSF leak, haemotympanum