Facial trauma can compromise the airway or cause head or neck injuries. Immediate respiratory obstruction may be caused by tooth fragments, blood, or loss of tongue control while delayed obstruction occurs from swelling. Semiprone positioning and avoiding wound edge inversion are recommended. Maxillary fractures include LeFort types I-III. Zygomatic fractures are "tripod" fractures. The mandibular condylar neck is the most common fracture site. Prophylactic antibiotics and dexamethasone can help manage facial trauma while safety measures reduce injuries.

1. MAXILLOFACIAL TRAUMA

2. Even trivial blows to the face may
• compromise the airway
• directly or indirectly cause a head injury
• cervical spine injuries
Commonly from sporting activities, accidents and
intentional violence.

3. Immediate or delayed respiratory obstruction.
Immediate obstruction may arise from
- inhalation of tooth fragments
- accumulation of blood and secretions
-loss of control of the tongue in the unconscious or
semiconscious patient
Delayed obstruction may arise from oedema , which tends to
develop within 60-90 minutes
Sustained bleeding may be due to accompanying skeletal
fractures or a ruptured viscus

4. ▪ The patient should be nursed in the semiprone position
to allow secretions, blood and foreign bodies to fall
from the mouth.
▪ neck should be supported by a protective collar
Patients with facial injuries should not be
allowed to lie supine

5. Lacerations and Soft tissue
injuries
Systemic examination the bones
Dental Occlusion, Palpation of
mouth
Cranial Nerves

6. Systemic palpation of bones, starting from,
Vault of skull, including the occiput
Face is palpated from front, bilaterally from,
Supraorbital and
Infraorbital ridges
The Nasal bridge
The Zygomatic bone
Zygomatic arch
Temporomandibular joint
Ramus of Mandible
Angle of Mandible
Body of Mandible
Symphysis of Mandible
•Tenderness
•Swelling
•Step deformity
•Crepitus

7. Trismus
Teeth present
Occlusion
Ecchymosis, Lacerations,
Hematoma
Palpate for Tenderness
Step deformity
Mobility
Mobility of the
Maxilla and
Mandible to be
assessed.

8. ▪Paresthesia suggests a fracture proximal
along the course of nerve.
▪Facial nerve palsy  fractured temporal
bone / penetrating parotid injury
▪Pupil size and light reflexes
▪Diplopia
•Cheek , upper lip floor of orbit
•Lower lip  fracture of mandibular body

9.  Coronal Computed
Tomography (CT)
Coronal and Axial CT
Chest X-Ray
Postero-anterior
Occipitomental
Radiographs
Orthopantomogram

10. Wounds must be thoroughly cleaned of dirt and debris to avoid tattooing.
Replace tissues accurately, especially
Vermilion border of lips
Eyelids
Nasal contours
Muscles and underlying
tissues should be brought
together with absorbable
sutures so that edges of
wound lie passively within
2mm of their final position.
Fine monofilament
sutures(5-0 or 6-0) are used
to bring the wound edges
together AVOID INVERSION OF WOUND EDGES

11. FACIAL NERVE INJURY:
-PRIMARY REPAIR IS THE MOST
APPROPRIATE TREATMENT
PAROTID GLAND INJURY:
-A FINE CANNULA IS INSERTED
WITHIN MOUTH INTO PAROTID
DUCT AND ANATOMOSIS OF
SEVERED PORTIONS OF DUCT IS
DONE, WITH THE CANNULA KEPT
AS A STENT INSIDE THE DUCT FOR
14 DAYS
PAROTID DUCT CANNULA

12. Upper Third 
above the
eyebrows –
involves frontal
sinus and
supraorbital
ridges
Middle Third 
above the mouth
– Le Fort I,II,III
Lower Third 
mandible

13. -Presence of depressed
frontal bone fractures and
fractures of the posterior wall
of the frontal sinus require
neurosurgical collaboration
-fractures of the anterior wall
of the sinus are treated with
reduction and fixation through
bicoronal scalp flap

14. Rene LeFort

15. LE FORT TYPE I
▪ # LINE RUNS ABOVE AND PARALLEL TO THE PALATE &
EFFECTIVELY SEPERATED ALVEOLUS AND PALATE FROM
THE FACIAL SKELETON ABOVE.
• CROSSES LOWER PART OF NASAL SEPTUM, MAXILLARY
ANTRA AND PTERYGOID PLATES.
TRANSVERSE

16. LE FORT TYPE II
• PASSES THROUGH THE ROOT OF NOSE, LACRIMAL BONE, FLOOR OF
ORBIT , UPPER PART OF MAXILLARY SINUS & PTERYGOID PLATES.
• ORBITAL FLOOR IS ALWAYS INVOLVED INFRAORBITAL NERVE
PYRAMIDAL

17. LE FORT TYPE III
• COMPLETE SEPERATION OF FACIAL BONES FROM CRANIAL BONES.
• # LINES RUNS THROUGH NASAL BRIDGE, SEPTUM AND ETHMOIDS,
AND THROUGH BONES OF ORBIT TO FRONTOZYGOMATIC SUTURE.
CRANIO-FACIAL DYSJUNCTION

18. •Upper part of face is first stabilised by bicoronal approach at the
vault of the skull
•Incisions in the lower eyelid are used to explore fractures of
orbital floor
•Lower part of Maxilla is approached through a gingival sulcus
incison above maxillary teeth.
•Reduction of Maxilla with Rowe’s disimpaction forceps which
grasp the palate between the nasal and palatal mucosa
■ Intermaxillary fixation screws or dental arch bars or eyelet wires
may be needed to achieve the correct occlusion

19. ROWE’S
DISIMPACTION
FORCEPS
INTERMAXILLARY
FIXATION

20. ▪ SECOND MC FRACTURED
BONE OF FACE AFTER
NASAL BONE.
▪ TRIPOD FRATURE , AS
ZYGOMA IS FRACTURED
AT ITS 3 PROCESSES
1) ZYGOMATICO-FRONTAL
2) ZYGOMATICO-TEMPORAL
3) INFRA-ORBITAL

21. • STEP DEFORMITY AT
INFRA-ORBITAL
MARGIN.
• FRACTURE IN
ORBITAL FLOOR MAY
CAUSE HERNIATION OF
ORBITAL CONTENTS
INTO MAXILLARY
SINUS.

22. •FLATTENING OF MALAR PROMINENCE.
• EPISTAXIS.
• ANAESTHESIA IN DISTRIBUTION OF INFRA-
ORBITAL NERVE
• TRISMUS-DEPRESSION OF ZYGOMA ON
CORANOID PROCESS.
• DIPLOPIA-ENTRAPMENT OF INFERIOR
RECTUS MUSCLE.
• SUBCONJUCTIVAL HEMORRHAGE
•OBLIQUE PALPEBRAL FISSURE -DISPLACEMENT
OF LATERAL PALPEBRAL LIGAMENT.
• PERIORBITAL EMPHYSEMA

23. • Diagnosis-
-X-RAY WATER’S VIEW.
-C.T.SCAN.

24. • Gillies temporal approachan
incision in the hairline, superficial to the
temporal fossa, about 15 mm long, at
45° to the vertical.
•Zygomatic arch is elevated by Bristow
or Rowe elevator

25. BRISTOW PERIOSTEAL
ELEVATOR

26. ▪Regular postoperative observations
must be made for retrobulbar
haemorrhage
• Forced duction test to ensure no limitation of
movement of the inferior oblique and inferior
rectus muscles

27. DIRECT BLUNT
TRAUMA
ORBITAL FLOOR – WEAKEST PART , IS FRACTURED
HERNIATION OF SOFT TISSUE INTO MAXILLARY ANTRUM
INFERIOR OBLIQUE AND INFERIOR
RECTUS MUSCLES –
ENOPHTHALMOS AND DIPLOPIA
INFRA ORBITAL NERVE-
NUMBNESS OF CHEEK
TREATMENT: Defects of the orbital floor can be
made up with bone graft or with
synthetic materials like Titanium Mesh.

28.  comminuted fractures
involving the nasal bones,
maxilla, infraorbital rims and
the frontal bones.
cause significant deformity
due to disruption of the
medial canthal ligaments may
cause traumatic telecanthus
(widened intercanthal distance)

29. Sites of Mandibular Fracture
inlcudes,
 Condylar Neck-weakest
part,most frequent site
through unerupted teeth (the
impacted wisdom tooth)
where the roots are long (the
canine tooth).
 The mandible may fracture directly
at the point of the blow, or indirect
transmission of the kinetic energy
causes a unilateral or bilateral
fracture of the mandibular condyles.

31. PLATING HAS MADE LONG TERM JAW WIRING ALMOST REDUNDANT
INDIRECT REDUCTION
AND FIXATION BY
INTERMAXILLARY
FIXATION(IMF)
OPEN REDUCTION AND
RIGID INTERNAL
FIXATION WITH
TITANIUM FIXTURES
AND MINI PLATES

32. FRACTURES OF MANDIBULAR CONDYLES
DEVIATION OF
MANDIBLE TO THE
SIDE OF FRACTURE
Fixation of mandibular
condyles
■ If displaced or bilateral, with
significant occlusal disturbance,
surgical intervention will be
requiredOpen reduction and
fixation
■ Reduction and plating helps
prevent anterior open bite, due
to malocculsion

33. FACIAL INJURIES MAY CAUSE EITHER IMMEDIATE OR DELAYED RESPIRATORY
OBSTRUCTION
SEMIPRONE POSITION
AVOID INVERSION OF WOUND EDGES IN SUTURING FACIAL LACERATIONS
FRACTURE OF MAXILLA – LE FORT TYPE I – TRANSVERSE #, TYPE 2- PYRAMIDAL ,
TYPE 3 – CRANIOFACIAL DYSJUNCTION
ZYGOMATIC FRACTURES ARE TRIPOD FRACTURES
THE CONDYLAR NECK IS THE WEAKEST PART AND MOST COMMON SITE OF
MANDIBULAR FRACTURE

34. Prophylactic antibiotics like penicillin / amoxycillin and
metronidazone should be given in all facial fractures
Dexamethasone may help to reduce facial oedema
Air bag provision, seat belts, laminated windscreens,
and drink/drive laws help to reduce the orofacial injuries