Maxillofacial Injuries (Sources: OH'S)

Question 1

Describe the epidemiology of these injuries

Answer 1

Majority in the 20-25 year old age
More males than females
Blunt injuries account for 98%
MVA is the top cause followed by falls, assault, contact sports and industrial accidents

Question 2

Describe mandibular fractures

Answer 2

The mandible is a horseshoe-shaped structure
Fractures tend to occur at the weakest points, regardless of point of impact - these are the condylar area, followed by the symphyseal and parasymphyseal areas and then the angle
Multiple fractures are common
Airway obstruction may occur after bilateral mandibular angle or body fractures due to posterior displacement of the tongue

Question 3

Describe midface fractures

Answer 3

The facial bones are thin and poorly reinforced
Patients tend to have multiple complex facial fractures rather than an isolated fracture
Le Fort describes 3 different patterns of facial fracture
These fractures occur perpendicular to the three main vertical buttresses of the facial skeleton - the nasomaxillary, zygomaticomaxillary and pterygomaxillary ‘pillars’

Question 4

Describe a Le Fort I fracture

Answer 4

Also known as a Guerin’s fracture
Involves only the maxilla at the level of the nasal fossa
The fracture separates the palate from the rest of the facial skeleton

Question 5

What is a Le Fort II fracture?

Answer 5

The most common mid face fracture
The maxilla, nasal bones and medial aspect of the orbit are involved, resulting in a freely mobile, pyramidal-shaped portion of the maxilla

Question 6

Describe a Le Fort III fracture

Answer 6

Also known as craniofacial disjunction because the fracture line runs parallel to the base of the skull, separating the mid facial skeleton from the cranium
The fracture extends through the upper nasal bridge and most of the orbit and across the zygomatic arch

Question 7

How should you approach assessing facial injuries (after immediate life-threatening problems have been managed?)

Answer 7

Review mechanism
Physical exam includes: inspecting for deformity, enopthalmos, asymmetry, dental malocclusion, nasal septum deviation or haematoma, CSF rhonnorhoea, extent of jaw opening, visual acuity, eye movements, corneal integrity and pupillary reflexes should also be assessed.
Check facial nerve function
Pain on bimanual palpation of the alveolar [rocess or the infraorbital rim or frontozygomatic suture line indicate mid face fracture

Question 8

How should maxfax injuries be investigated?

Answer 8

CT scan - in particular 3D reconstruction is the most accurate method if imaging.
Nasal discharge can be assessed for B2-transferrin to confirm presence of CSF fistula