This document discusses various types of facial bone fractures including the nasal bones, maxilla, zygomatic bones, and mandible. It describes the common causes of facial fractures such as road traffic accidents, falls, assaults, and sports injuries. The key aspects of managing facial trauma are controlling airway, hemorrhage, and treating associated injuries. Examination involves checking specific areas of the face. Treatment options depend on the type and severity of the fracture and may include closed or open reduction as well as splinting or internal fixation with plates or screws.
2. Introduction
• Facial bones fractured are
• Frontal bone
• Nasal bone
• Maxilla bone
• Zygomatic bone
• Mandible bone
3. • Nasal bones are the most
common types of facial
fractures
–Face is specifically targeted
during assaults
4. Etiology
• Road Traffic Accident
• Fall from height
• Assault
• Sports injury
• In children
–‘–‘Fall’ while playingFall’ while playing
––Child abuseChild abuse
5. Management of facial
trauma
• Manage airway, breathing and circulation
• Control hemorrhage
• Treat associated injuries of head, neck,
cervical spine, chest, abdomen, pelvis
and limbs
• Wound debridement
• Treatment of maxillo -facial bone injury
6. Examination of facial injuries
• EYES :Palpate orbital margins
especially floor
• NOSE : Look for external deformity
: Palpate for bony
crepitus : Rule out
septal hematoma/CSF leak
• MIDDLE 3rd
: Palpate bony contour of
face : Step
deformity :
Surgical emphysema
: Infraorbital & facial nerve deficit
• MANDIBLE : Blood stained saliva
: TMJ tenderness
: Feel jaw outline
8. • Type of Nasal Injury depends on
• Direction of Blow: Frontal/Lateral/ From
Below
• Force of Blow
• Nasal Fractures divided into 3 Types ( Moore
1989)
• Class 1:
• Green Stick Injury
• Simple Depression of Nasal Bone
• Chevallet Fracture
• Class 2 : Jarjavay Fracture
9. Depressed fracture
• Medium forceMedium force
–– Open book fractureOpen book fracture where nasal septumwhere nasal septum
collapses and nasal bones splay outcollapses and nasal bones splay out
• Greater forceGreater force
–– Nasal bones shattered, splaying ofNasal bones shattered, splaying of
frontal processes of maxillafrontal processes of maxilla
11. Angulated fracture
• Medium force → Ipsilateral nasal bone
fracture
• Greater force → B/L nasal bones and septum
fracture and deviation of nasal bridge
12. Clinical features
• External nasal
deformity
• Epistaxis
• Laceration of skin of
nose
• Edema over nasal
bridge (within few
hours of injury )
14. Treatment
• Fractures without displacement : no
treatment
• Fractures with displacement : closed
reduction
• Open reduction required rarely for
• Infection
• Comminuted fracture
15. Guidelines for treatment of nasal
bone fractures
• Closed reduction done before edema
appears (3hours) or after edema subsides
(7 days)
• Nasal fracture heals by 2 wk in adults and
1 wk in children. Closed reduction is to
be done before healing
16. Closed reduction
1. Lift non-depressed nasal bone laterally
with Walsham’s forceps
2. Lift depressed nasal bone laterally with
Walsham’s forceps
3. Nasal septal fracture reduced by lifting
it with Asch’s forceps
4. Both nasal bones brought into midline
by firm digital pressure from outside
23. Boies elevator
• Boies elevator is inserted
into the nostril deep to
displaced nasal bone
• Blade of elevator opposes
thumb of surgeon placed
outside the nose
• Raise & depress misaligned
bones to their original
32. Types
Le Fort 1 = Transverse
Le Fort 2 = Pyramidal
Le Fort 3 = Cranio -facial
dysjunction
33. Le Fort 1 (Guerin) fracture
Runs above nasal floor, through nasal
septum, maxillary sinuses & inferior
parts of pterygoid plates
34. Le Fort 2 fracture
Runs obliquely from maxillary sinus floor to
infraorbital
margin, across orbital floor & lacrimal bone
to nasion
35. Le Fort 3 fracture
Runs from medial orbit wall to superior
orbital fissure across sphenoid &
zygomatic bone to zygomatico -frontal
suture inferiorly to pterygoid plates
36. Fracture reduction
• Closed methods
• Hard palate disimpaction with Rowe’s
forceps
• External fixation on halo frame, box
frame
• Inter-maxillary fixation
• Open methods
• Inter-osseous wiring
44. Clinical Features
• Enophthalmos
• Orbital emphysema
• Inferior rectus &
orbital tissue get
trapped in # site →
prevents upward eye
movement →
diplopia
• Orbital hemorrhage
53. Gillie’s approach
• Incision made 4 cm superior to zygomatic
arch & posterior to temporal hairline
• Periosteal elevator carried forward,
between the temporalis fascia &
temporalis muscle & positioned beneath
zygomatic arch
• Lateral traction is placed on zygomatic
58. Clinical features
• Trismus
• Malocclusion of teeth
• Ecchymosis of oral mucosa
• Tenderness at site of fracture
• Crepitus at site of fracture
• Step-deformity on palpation
