FACIO-MAXILLARY INJURY

 
The facio-maxillary injury is usually obvious clinically.
Haemorrhage and upper airway obstruction are the most important aspects of facio-maxillary injuries.

Airway

Examination Equipment Requested

Intra oral examination requires a good light and two pairs of hands.

Check for chest injures.
Check patients overall clinical state - if shocked, then there are other injuries apart from facio-maxillary trauma.
Facio-maxillary injuries obscure other injures.

NO NOT FORGET TO LOOK FOR CONTACT LENSES.

Mandible

Most common fracture site is the subcondylar region. It is a ring of bone somewhat like the Pelvis, so if you see one fracture look for others elsewhere. Isolated fractures of the subcondylar region are common and treated conservatively.

Other common sites

X-RAYS in two planes:

PLATING - INTERNAL FIXATION - Patients can resume eating quite easily and can resume work in two weeks.

INFECTION CONCERN - any fractures of the tooth bearing region should be admitted. Avoid abscess formation, Osteomyelitis of the jaw. By admission to Hospital proper antibiotic regime and oral hygiene can be given.

Malar

lateral middle third Zygomatic bone, i.e. cheek bone eminence.

X-RAYS

Blow Out Fracture

Middle Third Fracture

X-RAYS

CT SCAN

More useful than x-rays, take instead of x rays if high clinical suspicion.

Le Fort Fractures

Tested by putting hand under the occiput, fingers on the R & L molar teeth and NOT on the palate.

Le Fort 1

Le Fort 2

Le Fort 3

Signs

Marked swelling - dished in appearance.

Check

Aims

Adapted from Box Hill Emergency Manual
SLJ 4/10/2000