TRAUMA TO FACE

SYNOPSIS

• INTRODUCTION
• SOFT TISSUE INJURIES
• BONE INJURIES
• FRACTURES OF UPPER 1/3 OF FACE
• FRACTURES OF MIDDLE 1/3 OF FACE
• FRACTURES OF LOWER 1/3 OF FACE
 INTRODUCTION

• Injury to face involves SOFT TISSUE and BONES

• Mechanism of injury
 RTA
 BLOW TO FACE
GUNSHOT
BLUNT FORCE TRAUMA
SOFT TISSUE INJURIES
 BONY INJURIES

FRACTURES OF ABOVE THE LEVEL OF

UPPER 1/3 OF FACE SUPRAORBITAL RIDGE

FRACTURES OF B/W SUPRAORBITAL

BONY INJURIES RIDGE AND UPPER
MIDDLE 1/3 OF FACE
TEETH

FRACTURES OF MANDIBLE AND

LOWER 1/3 OF FACE LOWER TEETH
FRACTURES OF UPPER 1/3

FRACTURES OF UPPER
FRONTAL
SINUS#
SUPRAORBITAL
1/3 #
FRONTAL BONE
#
FRONTAL SINUS FRACTURE
 CLINICAL FEATURES

• Forehead lacerations
• Tenderness
• Parasthesias
• Haematoma
• CSF Rhinorrhoea
FRONTAL SINUS FRACTURE
 SUPRAORBITAL RIDGE FRACTURES

• Ridge fractures present as

• Periorbital ecchymosis
• Flattening of eyebrow
• Proptosis
• Treatment : open reduction through eyebrow incision
 FRONTAL BONE FRACTURE

• May be depressed or linear

• Associated with cerebral edema and brain injury
 FRACTURE OF MIDDLE 1/3

FRACTURES OF MIDDLE 1/3

NASAL BONE
MAXILLA ZYGOMA
& SEPTUM
 NASAL BONE FRACTURES

NASAL DEPRESSED : OPEN BOOK FRACTURE,CAUSED

BONE
FRACTURES BY FRONTAL BLOW,GREATER FORCE CAUSES
COMMINUTED#

ANGULATED: CAUSED BY LATERAL BLOW,

CAUSES FRACTURE OF NASAL BONES WITH
DEVIATION OF NASAL BRIDGE
 CLINICAL FEATURES

• Swelling and deformity of nose

• Tenderness
• Crepitus
• Epistaxis
• Nasal obstruction
TREATMENT
 FRACTURE OF ZYGOMA

• 2nd most common fracture

• Caused by direct trauma
• Also known as tripod fracture
• CLINICAL FEATURES
• Fattening of malar prominence
• Step deformity
• Trismus
• Restricted ocular movements
 TREATMENT

• Investigations : X ray PNS waters view, CT facial bones

• Treatment : OPEN REDUCTION AND INTERNAL WIRE FIXATION
• Incision is made in lateral brow and infraorbital region and wire fixation is done
at frontozygomatic region
 FRACTURE OF MAXILLA

LEFORT I : Crosses lower part of nasal septum maxillary antrum

pterygoid plates

LEFORT II: Passes through root of nose,lacrimal bone,floor of

orbit,upper part of maxillary sinus,pterygoid plates

LEFORT III : Passes through root of nose ,ethymoidofrontal

junction,superior orbital fissure,lateral wall of
orbit,frontozygomztic and temporozygomztic sutures
FRACTURE OF MAXILLA
INVESTIGATIONS: X RAY PNS WATER VIEW, LATERAL VIEW,CT
SCAN
 TREATMENT

• Inter dental wiring

• Intermaxillary wiring using arch bars
• Open reduction and interosseous wiring
 FRACTURE OF MANDIBLE
• Fractures of mandible caused by direct trauma
 CLINICAL FEATURES

• In CONDYLAR FRACTURES
• PAIN AND TRISMUS
• MALOCCULUSION OF TEETH , DEVIATION OF JAW
• IN FRACTURE OF ANGLE,BODY,
• STEP DEFORMITY
• ECCHYMOSES
 TREATMENT

• IN CLOSED METHODS : interdental wiring & intermaxillary fixation

• IN OPEN METHODS : Direct interosseous wiring ,wire tied in figure of eight
manner