Facial fractures develop after various forms of trauma, with motor vehicle accidents, contact sports, and both accidental or intentional injuries being most common. Numerous anatomical sites may be a potential site for fracture, and multiple fractures are not uncommon, especially in the setting of more severe trauma. The diagnosis is made by a thorough physical examination and imaging studies.
Numerous anatomical structures of the face may be a site of fracture, which is why the clinical presentation may significantly vary. In general, trauma is the cause of fracture, but the mode of injury significantly changes across different age groups. In children, falls and contact sports are most important forms of trauma, whereas intentionally inflicted injuries and motor vehicle accidents are more prevalent among adults . Facial fractures are predominantly seen in males and the following sites may be involved :
•Frontal bone and the frontal sinus - Although considered to be one of the less common sites of facial fracture overall , infants and young children can suffer from severe injury of the frontal bone and the surrounding area due to its underdevelopment, and central nervous system injury may be one of the most important complications .
•Nasomaxillary area and the orbit - The zygomatic area, the nose and the orbit are the sites where fractures are predominantly encountered in clinical practice   . Periorbital edema, lower eyelid ecchymosis and subconjunctival hemorrhage presenting as a "bloodshot eye" are signs of orbital trauma and possible fracture , while visual deficits, facial widening, flattening of the malar region, enophthalmos and dental abnormalities are common signs when the entire area is affected . It must be noted that orbital and midfacial fractures carry a significant risk for blindness due to optic nerve injury . In addition, rhinorrhea, epistaxis or leakage of cerebrospinal fluid (CSF) may occur when fractures of the nose and cribriform plate are encountered . If not adequately managed, meningitis, sinusitis, as well as the development of a mucocele are known complications .
•Jaw fracture - Fractures of the mandibular condyle are also one of the most important sites of fracture in children, but damage to the jaw presenting with jaw pain, tenderness, facial asymmetry, deviation of the chin, displacement of the jaw and the teeth and paresthesias   may also occur.
The extent of injury may be quite severe and many patients suffer from multiple fractures of the face simultaneously, especially in severe forms of trauma, such as motor vehicle accidents. For this reason, a detailed patient history regarding the mode of injury and a thorough physical examination of the face is pivotal in the assessment of facial fractures. Firstly, a complete inspection and palpation of the face should reveal signs and symptoms that point to a fracture of a specific site, but because not all bones can be evaluated during the physical examination, implementation of various imaging studies should be the next step in workup . Plain radiography of the cranium is initially performed, but computed tomography (CT) provides a better view into the skeletal structures of the head. For this reason, it is considered to be the gold standard in the diagnosis of facial fractures  . Moreover, a panoramic CT is advocated in the setting of mandibular fractures, but the use of panoramic X-ray imaging as an adjunctive procedure has been well-established, especially when CT findings yield inconclusive results regarding dental injury .