85 - Repair of facial fractures

Summary

The increased incidence of patients with facial fractures relates to the frequency of motor vehicle accidents. Management of these patients requires a team approach, as they usually present with multiple injuries. Proper treatment includes resuscitation, early care, and late reconstruction. Emergency management involves airway control, control of bleeding, and identification of occult injuries. As soon as the patient is stabilized, early care begins with a clinical examination that focuses on occlusion of the mandible, evaluation of sensory and motor nerves, assessment of the muscles of extra-ocular movement, and the identification of open fractures such as those involving the mandible. Next, radiographic imaging of the face is ordered to determine exact fracture patterns. Imaging studies may include CT scans, plain films, and specialized views such as Panorex films of the mandible; however, a CT scan with fine cuts of the face and mandible is the preferred modality.

Soft tissue injuries in the form of contusions, lacerations, and avulsions are identified and treated primarily. Treatment plans for the craniofacial skeleton are tailored to specific fracture patterns. Repair of facial fractures is indicated to restore both appearance and function, particularly in mandible and orbital floor fractures where such qualities are greatly at risk. The general principle of accurate reduction and proper fixation applies to facial injuries as well. Facial fractures are approached through a variety of incisions. Reduction is evaluated with mandible occlusion and direct visualization of bone segments. Fixation is performed with wires, plates, and screws and intermaxillary fixation.