Fracture of the facial bones-Nose,Maxilla,Mandible,Zygomatic

FRACTURE OF THE FACIAL BONES
  • Fractures of the facial bones may be divided as follows:
A.)Fractures of upper third-Above Supraorbital Ridge
  • Frontal Sinus,Supra-orbital Ridge,Frontal bones
B.)Fracture of Middle third-Between supra-orbital ridge and upper teeth
  1. Nasal Bones and Nasal Septum
  2. Naso-orbital
  3. Zygomatic bone
  4. Floor of Orbit
  5. Maxilla
C.)Fractures of lower third
  1. Mandible
  2. Alveolus
  3. Temporomandibular joint
FRACTURE OF NASAL BONES
  • Nasal fracture is the most common facial fracture, and the third most common fracture of the skeleton overall.
  • Aetiology:Direct trauma to the nose or Face,Head injury
  • Types:
  1. Depressed-when the injury is from front
  2. Angulated-due to injury from side
  • Clinical features:
  1. External Nose may be swollen and deformed.Crepitus may be felt.
  2. Epistaxis,Nasal Blockage
  3. Investigations:
  • Radigraph of the Lateral view of the nose shows Fracture of Nasal bone with or without Displacement
  • Treatment:Reduction of fracture required if the fracture fragment is displaced.
FRACTURE OF MAXILLA
  • It is classified into 3 types : 
  1. Le Fort I (transverse)-
  2. Fracture runs above and parallel to the plate. It crosses lower part of nasal septum, maxillary antra and the pterygoid plates.
  3. Le Fort II (pyramidal) fracture-
  4. Passes through the root of nose, lacrimal bone, floor of orbit, upper part of maxillary sinus and pterygoid plates on both the sides.
  5. Le Fort III (craniofacial dysjunction)-
  • There is complete separation of facial bones from the cranial bones.
  • The fracture line passes through root of nose, ethmofrontal junction, superior orbital fissure, lateral wall of orbit, frontozygomatic and temporozygomatic sutures and the upper part of pterygoid plates.
Clinical features:
  1. Depneding on the type of fracture,the following features are seen:
  2. Nose-Nasal bridge collapses,Epistaxis,Nasal obstruction,CSF Rhinorrhea
  • CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II and type III (as cribriform plate is injured here) and also in naso-ethmoid fracture
  1. Maxillary sinuses-Step deformity of the infra-orbital margin,Numbness of the cheek
  2. Eyes-Subconjunctival hemorrhage,Diplopia,Epiphora
  3. Face-Dish-face deformity with the flattening of the face
  4. Malocclusion of the jaws
  • Investigations;
  1. Radiograph and CT scan of Facial bones(more precise)-reveals the fractures and displacement.
  • Treatment
  1. After the Oedema of the soft tissue subsides,the fractures are reduced under general anesthesia.
  2. Maintainence of reduction is performed by splints,rods,bars,or continuous traction
FRACTURE OF ZYGOMATIC BONE
  • Zygoma fracture is also known as tripod fracture.
  • Clinical features :
  1. Considerable swelling over zygomatic arch is common 
  2. Flattening of malar prominence.
  3. Step-deformity of infraorbital margin.
  4. Anaesthesia in the distribution of infraorbital nerve.
  5. Trismus, due to depression of zygoma on the underlying coronoid process.
  6. Oblique palpebral fissure, due to the displacement of lateral palpebral ligament.
  7. Restricted ocular movement, due to entrapment of inferior rectus muscle. It may cause diplopia. 
  8. Periorbital emphysema, due to escape of air from the maxillary sinus on nose-blowing.
  9. The mucosa of the maxillary sinus may be lacerated and cause epistaxis on that side.
  10. Fracture of the zygoma may or may not be painful to palpation and running a finger along the zygomatic arch may give a feel of a depressed fracture or a small dimple. Investigations;
  11. Radiograph and CT scan of Facial bones(more precise)-reveals the fractures and displacement.
  • Treatment
  1. Zygomatic arch is to be elevated.Reduction is performed by an external incision or via Caldwell -luc approach.Wiring or packing the maxillary antrum maintains the reduction of the fracture.
FRACTURE OF MANDIBLE
  • Condylar process fractures of the mandible are most common account for 35% of all the fractures of mandible. They are followed by angle, body and symphysis in decreasing order of frequency.
  • Clinical features
  • Pain,Swelling,Deformity with trismus or malocclusion of teeth
  • Treatment:
  1. The fracture is reduced and fixed by:
  2. Closed reduction or Open reduction.
Exam Question
  • Le Forte II facial fracture implies Fracture running through zygomatic process of the maxilla, floor of orbit, root of nose on both the sides.
  • Craniofacial dissociation is seen in Le Fort 3 fracture.
  • CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II and type III (as cribriform plate is injured here) and also in naso-ethmoid fracture
  • Bone commonly fractured in facial injuries is Nasal Bones.
  • Most common site for fracture mandible is Condyle.
  • LeFort's fracture would include Maxilla,Zygoma and Nasal Bones,
  • Tripod fracture is the name given for Zygomatic fracture.
  • Pyramidal fracture of maxilla is Le Fort-2

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