MINORS MANUAL
Facial fractures are traumatic injuries affecting the bones of the face, such as the maxilla, mandible, cheekbones, nose, or orbit. These fractures commonly result from car accidents, falls, or assaults. In addition to damaging the bone structure, facial fractures can compromise the function of nearby organs, such as the eyes, airway, or teeth, and may cause visible deformities.
Diagnosis
Diagnosis is based on physical examination, looking for signs of facial deformity, pain, bone crepitus, bruising, and changes in bite or vision. Imaging studies like X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) are essential to confirm the type and extent of the fracture. Airway patency and any neurological involvement must also be assessed.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Facial contusion | Swelling and bruising, no bone instability |
Mandibular dislocation | Jaw displacement, inability to close the mouth |
Periorbital haematoma (black eye) | Swelling and bruising around the orbit, no bone fracture |
Acute sinusitis | Pain in the maxillary area, no history of trauma |
Emergency Management
Airway assessment: In severe facial fractures, ensure the airway is not compromised due to bone displacement or bleeding. Be prepared for intubation or tracheostomy in severe cases.
Haemorrhage control: Apply direct pressure to stop external bleeding. Significant internal bleeding may require urgent surgical intervention.
Immobilisation: For mandibular or maxillary fractures, use a compressive bandage or immobilisation device until definitive evaluation.
Pain and anti-inflammatory management: Administer medications to control pain and reduce swelling.
Neurological and ocular evaluation: Check cranial nerve function and visual status, especially in orbital fractures.
Diagnostic imaging: Request high-resolution facial CT scans to determine the type and extent of the fracture.
Antibiotic prophylaxis: In open fractures or fractures communicating with the sinuses, start antibiotics to prevent infection.
Definitive Treatment
Definitive treatment depends on the severity of the fracture. Non-displaced fractures can be managed conservatively with immobilisation, while displaced or unstable fractures require open reduction and internal fixation (ORIF), usually performed by a maxillofacial or plastic surgeon.
Surgical reconstruction ensures the restoration of both function and aesthetics of the facial structures. In cases of orbital fractures, repair may be necessary to prevent complications such as diplopia or enophthalmos.
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