In this section : Oral & Maxillofacial Surgery
Dental Abscess
Facial Trauma – Mandibular Fractures
Facial Trauma – Orbital Fractures
Facial Trauma – Zygoma
Facial Trauma – Mandibular Fractures
Last updated 5th March 2024
Overview
- The clinical spectrum of facial trauma ranges from minimal soft tissue injuries to life threatening panfacial trauma.
- This guide aims to outline basic assessment, early management and referral pathways for the more common patterns of facial trauma namely:
- Fractures of the mandible
- Fractures of the zygomatic complex/arch
- Orbital fractures
- At presentation patients should be managed according to ATLS protocol so that life-threatening injuries/complications are prioritised.
Clinical Features
- Common findings on assessment include
- Pain and swelling over fracture site
- Limitation of jaw movement
- Malocclusion: An inability to bring teeth into normal occlusion or an obvious step in occlusion (this can easily be mistaken for an avulsed tooth socket)
- Palpable bony step
- Sublingual haematoma (almost pathognomic of mandible fracture)
- Inferior alveolar nerve injury (lip/chin numbness)
- Always look for more than one fracture as bilateral fractures frequently occur
- Ensure missing teeth/teeth fragments are accounted for
Imaging
- Minimum: Orthopantomogram (OPT) and PA mandible
- CT mandible may be appropriate if patient requires CT head or if intubated
- Consider CXR if teeth/teeth fragments are not accounted for
Management
- Fractures of the tooth bearing segment of the mandible are considered open fractures that require acute referral, IV antibiotics and most likely admission for open reduction and internal fixation.
- Unilateral condylar fractures/coronoid process fractures do not routinely require admission. These are closed fractures, do not require antibiotics and can be reviewed on an OMFS outpatient clinic in 5-7 days. If the patient is being discharged please send a referral to OMFS secretary [email protected] with a copy of the discharge letter. If the patient is remaining an inpatient for another reason please refer in-hours to OMFS on-call in DGRI.
- Bilateral condylar fractures may require admission due to risk of airway compromise and should be discussed acutely with OMFS on-call. These are closed fractures and do not require antibiotics.
Content by Lee Mackie, Updated by Gary Bell