Management of facial fractures

Abstract

Maxillofacial fractures are usually diagnosed easily by history, clinical findings, and standard roentgenograms. Emergency treatment centers around airway management; the conscious patient should be allowed to clear his own airway whenever possible. Treatment of lower and upper jaw fractures focuses on reducing the fragments so that dental occlusion is normal. Other midface fracture reductions require additional exact orbital rim alignment. Immobilization of fractures can require various combinations of intermaxillary fixation, interosseous wiring, suspensory wires from intraoral arch bars, transfacial Kirschner wires, occasional maxillary antral packs, and rare external fixation with headframes or external pins. Patients who may be comatose or seriously ill for several weeks should have a simple and safe compromise reduction and K-wire fixation done at the bedside. Management of blow-out fractures of the orbit and frontal sinus fractures is somewhat controversial. Naso-orbital central factial fractures are especially difficult to maintain in proper reduction. Listed are possible late postoperative complications after treatment of facial fractures.