MaxFax CBD (Facial Fractures)

Question 1

What are the causes of facial fractures?

Answer 1

Assault - 70-80%
RTA
Sports
Industrial
Falls

Question 2

What are the signs and symptoms of facial fractures?

Answer 2

Pain, swelling, loss of function, streps, crepitus

Question 3

What are the different types of facial fracture?

Answer 3

Simple/closed, compound/open, displaced or undisplaced, anatomical

Question 4

What are the first principles of assessing a suspected facial fracture?

Answer 4

ATLS principles
Airway
Breathing
Circulation
Consider C-spine injury

Question 5

What are the four most commonly fractures facial bones?

Answer 5

Mandible, maxilla, zygoma, nasal

Question 6

Basic Tx options for facial fracture?

Answer 6

Conservative non-surgical
Conservative surgical
Surgical

Question 7

What classifies a middle third facial fracture?

Answer 7

Central: maxilla/naso-orbito-ethmoidal complex
Lateral: zygomatico-orbital complex

Question 8

What classifies a lower third facial fracture?

Answer 8

The mandible

Question 9

What classifies an upper third facial fracture?

Answer 9

The frontal sinus

Question 10

Specific surgical Tx options for facial fractures?

Answer 10

Conservative cf POP cast
Intermaxillary fixation
Open reduction and internal fixation (ORIF)
Plate(s) at tension zones

Question 11

What are some general features of middle third fractures?

Answer 11

Usually blunt force, mid-high velocity, variable, may be complex, may be cranial and/or ocular involvement

Question 12

Presentation of middle third fractures?

Answer 12

Classical facial appearance, CSF leak?, airway, breathing, nerve anaesthesia?, midline split?, anterior open bite (AOB)

Question 13

Tx for middle third fractures? (central)

Answer 13

Conservative usually not possible - surgery often required - ORIF. Nasal reconstruction often required and primary bone grafting

Question 14

Features of lateral middle third fractures?

Answer 14

Zygomatic, (malar), may involve orbit/eye, common facial fracture, assault/sport/falls/RTA, may go unnoticed, orbital blow-out fractures

Question 15

Tx for middle third fractures? (lateral)

Answer 15

Conservative non-surgical
Conservative surgical - closed reduction, various methods, fixation required if not stable
Surgical - depends on type, various approaches

Question 16

What are the features of upper third fractures?

Answer 16

Often as a part of pakfacial injuries, usually compound skull fractures. May have an associated CNS injury