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Maxillofacial Injury
Aka: Maxillofacial Injury, Maxillofacial Trauma, Maxillary Fracture, Le Fort Fracture, Le Fort's Fracture, Fracture of Face Bones, Facial Fracture
- See Also
- Secondary Trauma Evaluation
- Head Trauma
- Neck Vascular Injury in Blunt Force Trauma
- Cervical Spine Trauma
- Basilar Skull Fracture
- History
- Le Fort was a French surgeon studying cadaver skulls he Traumatized in the late 1800s to early 1900s
- Types
- Le Fort Fracture Type 1
- Horizontal Fracture between the teeth and the Palate
- Le Fort Fracture Type 2
- Pyramidal Fracture from the the mid-Maxillary Sinus, through the inferior orbital rim to the Nasal Bridge
- Le Fort Fracture Type 3
- Vertical Fracture through the Maxillary Sinus lateral aspect and horizontal through the orbits
- Fracture includes the medial and lateral orbital walls
- Associated Conditions
- Head Trauma including Intracranial Hemorrhage
- Basilar Skull Fracture
- Cervical Spine Trauma
- Neck Vascular Injury in Blunt Force Trauma
- Eye Trauma
- Evaluate for Diplopia and Visual Acuity
- Epistaxis
- Imaging
- CT Maxillofacial
- Includes orbits, Maxilla, sinuses and Mandible
- Have a low threshold for contiguous imaging
- CT Head
- CT Cervical Spine
- Management
- Cervical Spine precautions
- ABC Management is paramount
- Ensure a patent and secure airway
- Avoid Nasogastric Tube, posterior Nasal Packing, nasal intubation (risk of Basilar Skull Fracture)
- Surgical airway (Cricothyroidotomy) may be needed
- Perform a complete Trauma Exam
- Neurologic Exam with careful Cranial Nerve exam
- Extraocular Movement, Pupil Reactivity, and ocular exam
- Evaluate for signs of Neck Vascular Injury in Blunt Force Trauma
- Resources
- Radiopaedia
- https://radiopaedia.org/articles/le-fort-fracture-classification
- University of Iowa
- https://medicine.uiowa.edu/iowaprotocols/facial-fracture-management-handbook-lefort-fractures
- References
- Karic, Shannon and Kiel (2019) Crit Dec Emerg Med 33(11):12-3