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Facial Fracture

Facial Bone Fracture

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.


Presentation

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 [1]. Facial fractures are predominantly seen in males and the following sites may be involved [2]:
•Frontal bone and the frontal sinus - Although considered to be one of the less common sites of facial fracture overall [3], 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 [1].
•Nasomaxillary area and the orbit - The zygomatic area, the nose and the orbit are the sites where fractures are predominantly encountered in clinical practice [2] [3] [4]. Periorbital edema, lower eyelid ecchymosis and subconjunctival hemorrhage presenting as a "bloodshot eye" are signs of orbital trauma and possible fracture [5], while visual deficits, facial widening, flattening of the malar region, enophthalmos and dental abnormalities are common signs when the entire area is affected [6]. It must be noted that orbital and midfacial fractures carry a significant risk for blindness due to optic nerve injury [6]. In addition, rhinorrhea, epistaxis or leakage of cerebrospinal fluid (CSF) may occur when fractures of the nose and cribriform plate are encountered [6]. If not adequately managed, meningitis, sinusitis, as well as the development of a mucocele are known complications [6].
•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 [1] [6] may also occur.

Overeating
  • The authors performed a retrospective study of life-threatening hemorrhage in facial fracture patients attending the Royal Adelaide Hospital over 20 years and report four recent cases.[ncbi.nlm.nih.gov]
  • The lowest collection rates were obtained from uninsured patients (10 percent total billing over collections).[ncbi.nlm.nih.gov]
  • Angiography showed diffuse extravasation of contrast medium over the territory of the right internal maxillary artery. Embolization was performed successfully to stop the bleeding.[ncbi.nlm.nih.gov]
  • Nonetheless, there has been virtually no inquiry evaluating whether these findings carry over to facial fracture.[ncbi.nlm.nih.gov]
  • NHL The Vancouver Canucks have a big void to fill on their blue-line after Dan Hamhuis suffered a facial fracture when he took a slapshot to the face in Wednesday night's 2-1 win over the visiting New York Rangers. He will have surgery on Friday.[cbc.ca]
Short Hands
  • Even if Westbrook returns, the Thunder will still be short-handed. All-Star forward Kevin Durant has been sidelined for six consecutive games with a foot injury.[foxsports.com]
Facial Burn
  • Midface trauma and facial burns were common. Approximately 64% of the study sample sustained traumatic brain injury. Overall, 45.6% (109/239) had at least one facial bone fracture.[ncbi.nlm.nih.gov]
Meningism
  • Of the 280 cases of bacterial meningitis, 48 patients had sustained dural tear following trauma. The prognosis for posttraumatic meningitis is considerably better than for other forms of meningitis.[ncbi.nlm.nih.gov]
  • If not adequately managed, meningitis, sinusitis, as well as the development of a mucocele are known complications.[symptoma.com]
  • Because the posterior wall is adjacent to the dura mater, damage in this region could result in central nervous system (CNS) complications such as a cerebrospinal fluid (CSF) leak or meningitis.[emedicine.medscape.com]
  • Besides surgical repair, the patient may need to have prophylactic antibiotics at the time of surgery in order to prevent meningitis and encephalitis.[autoaccident.com]

Workup

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 [5]. 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 [1] [6]. 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 [1].

Treatment

  • The authors have formulated a succinct treatment guideline. They favor angiographic embolization as the first choice of treatment when tight nasal and/or oral packing fails.[ncbi.nlm.nih.gov]
  • All patients received megadose corticosteroid treatment and were divided into 3 groups: (1) facial fracture repair alone, (2) optic nerve decompression (OND) facial fracture repair, or (3) nonsurgical treatment.[ncbi.nlm.nih.gov]
  • Abstract Rigid plate and screw fixation is the mainstay of treatment for complex fractures of the facial skeleton. Complications of plate and screw fixation include prominence, infection, exposure, and migration.[ncbi.nlm.nih.gov]
  • Treatment of facial fractures is similar to the treatment of a broken arm or leg.[northkitsapent.com]
  • We present four cases of traumatic optic neuropathy that compromised the treatment of facial fractures. The management of facial fractures in patients with traumatic optic neuropathy must proceed cautiously.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis for posttraumatic meningitis is considerably better than for other forms of meningitis. The preceding trauma involved the vault of the skull in 90% (43/48) of cases, and discrete middle third facial fracture in one case (2.1%).[ncbi.nlm.nih.gov]
  • Patients requiring OND fracture repair had a significantly worse visual prognosis.[ncbi.nlm.nih.gov]
  • Prognosis is usually good. Jaw (mandibular) fracture: Prognosis is usually good. Midface (maxillary) fracture People with midface fractures have a poorer prognosis because of other injuries suffered from the accident that caused their fracture.[emedicinehealth.com]
  • If the nerve is not severed due to trauma, the prognosis for return of sensation is quite good. A sunken eye can develop following an eye socket fracture.[facedoctornyc.com]

Etiology

  • Although some demographic data exists regarding the overall epidemiology of facial fractures, little attention has been paid to the patterns of facial fractures based on the etiology of the trauma.[ncbi.nlm.nih.gov]
  • The results confirm intuitive aspects of the etiology of facial fractures that have been anecdotally supported in the past.[ncbi.nlm.nih.gov]
  • These later differences in gender-related fracture incidence are often attributed to more frequent involvement in sports, physical activity, and dangerous behavior among boys. 5 Etiology The majority of facial fractures in children result from falls and[ncbi.nlm.nih.gov]
  • Further studies including facial fractures are always necessary, because the trends in the etiology of maxillofacial trauma are always changing, and the etiology of fractures may suggest new ways to prevent these injuries.[scielo.br]
  • Etiology and incidence of maxillofacial fractures in the north of Jordan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 86 :31–5. [ PubMed ] 3. Iida S, Matsuya T.[ncbi.nlm.nih.gov]

Epidemiology

  • CONCLUSIONS: Epidemiologic analysis of facial fractures identifies the most affected patient populations and the characteristics of their fractures.[ncbi.nlm.nih.gov]
  • METHODS: Epidemiology, mechanisms, fracture types, and outcome of facial fractures-associated blindness in a 10-year period are retrospectively reviewed. RESULTS: Out of 907 facial fractures patients, 10 had blindness, giving a frequency of 1.1%.[ncbi.nlm.nih.gov]
  • Although some demographic data exists regarding the overall epidemiology of facial fractures, little attention has been paid to the patterns of facial fractures based on the etiology of the trauma.[ncbi.nlm.nih.gov]
  • The increasing prevalence of facial bone injuries emphasises the necessity for epidemiological surveys to determine optimal prevention strategies and patient management.[ncbi.nlm.nih.gov]
  • The objective of this study was to present epidemiologic estimates of hospital-based emergency department (ED) visits for facial fractures in the United States. MATERIALS AND METHODS: The Nationwide Emergency Department Sample for 2007 was used.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • THE INCIDENCE, mechanisms, and pathophysiology of facial fractures are well described in the literature, as are the current approaches to fracture reduction and fixation. 1 - 5 The 3 goals of therapy in treating midfacial fractures are (1) to restore[jamanetwork.com]

Prevention

  • Alternative medications should be used for prevention of post-surgery nausea and vomiting in facial fracture patients. Copyright 2017. Published by Elsevier Ltd.[ncbi.nlm.nih.gov]
  • Other prevention strategies include: Following the rules Promoting fair play Ensuring proper supervision Wearing helmets in skateboarding and skiing/snowboarding Using nasal protectors in basketball and soccer, which may prevent some fractures; and Using[momsteam.com]
  • He may also prescribe antibiotics to prevent infection.[webmd.com]
  • This is to prevent an infection. Whenever you are prescribed antibiotics, it is important to finish the course as instructed. This is for your health and also to prevent the emergence of antibiotic resistance in the general population.[cuh.nhs.uk]

References

Article

  1. Cole P, Kaufman Y, Hollier LH. Managing the Pediatric Facial Fracture. Craniomaxillofac Trauma Reconstr. 2009;2(2):77-83.
  2. Holland AJ, Broome C, Steinberg A, Cass DT. Facial fractures in children. Pediatr Emerg Care. 2001;17(3):157-160.
  3. Hwang K, You SH. Analysis of facial bone fractures: An 11-year study of 2,094 patients. Indian J Plast Surg. 2010;43(1):42-48.
  4. Alvi A, Doherty T, Lewen G. Facial fractures and concomitant injuries in trauma patients. Laryngoscope. 2003;113(1):102-106.
  5. Ceallaigh PÓ, Ekanaykaee K, Beirne CJ, Patton DW. Diagnosis and management of common maxillofacial injuries in the emergency department. Part 3: orbitozygomatic complex and zygomatic arch fractures. Emerg Med J. 2007;24(2):120-122.
  6. Chao MT, Losee JE. Complications in Pediatric Facial Fractures. Craniomaxillofac Trauma Reconstr. 2009;2(2):103-112.

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Last updated: 2019-06-28 12:18