eMedicine Specialties > Plastic Surgery > Facial Fractures

Facial Trauma, Management of Panfacial Fractures: Workup

Author: Kris S Moe, MD, FACS, Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine; Clinical Associate Professor of Surgery, Division of Head and Neck Surgery, University of California, San Diego
Contributor Information and Disclosures

Updated: Sep 9, 2009

Workup

Imaging Studies

  • Order plain films as dictated by the physical examination findings.
  • Because of the complexity of these injuries, computed tomography (CT) imaging studies yield more accurate information related to the bony architecture and its disruption by injury than plain films.7
    • CT imaging is an integral component of the diagnosis of midfacial fractures. These patients often have a concomitant head injury and require a head CT scan to examine intracranial structures and exclude hemorrhage. Often, if the results are positive for injury, the CT scan needs to be repeated to look for worsening or resolution of an intracranial process.
    • Axial CT scans through the maxillofacial region can almost always be obtained while performing the initial head CT scan.

      Axial view demonstrating increased zygomatic widt...

      Axial view demonstrating increased zygomatic width.

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      Axial view demonstrating increased zygomatic widt...

      Axial view demonstrating increased zygomatic width.

    • Coronal CT scans are often difficult to obtain initially in patients who are still intubated and require cervical spine immobilization. Coronal and sagittal reconstructions can usually be obtained from the initial axial CT scans.

      Coronal view of patient with panfacial fractures ...

      Coronal view of patient with panfacial fractures from facial trauma.

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      Coronal view of patient with panfacial fractures ...

      Coronal view of patient with panfacial fractures from facial trauma.



      Coronal view demonstrating cant of maxilla and ma...

      Coronal view demonstrating cant of maxilla and mandible.

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      Coronal view demonstrating cant of maxilla and ma...

      Coronal view demonstrating cant of maxilla and mandible.

    • Three-dimensional CT imaging and computer-generated models of the facial skeleton can be useful in complex cases.8 They can aid in visualization and treatment planning of the bony injuries.9

      Three-dimensional reconstruction aids in treatmen...

      Three-dimensional reconstruction aids in treatment planning of these complex panfacial fractures.

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      Three-dimensional reconstruction aids in treatmen...

      Three-dimensional reconstruction aids in treatment planning of these complex panfacial fractures.

Diagnostic Procedures

  • One of the keys to repair or reconstruction of the maxillofacial skeleton is occlusion of the teeth. Dental models can be helpful in assessing the exact position of displaced segments of both the maxilla and mandible attached to teeth. Dental models are useful in the reconstruction of acrylic stents and splints for palatal fractures.
  • Preinjury photographs of the patient obtained from the family can be helpful in determining the patient's preinjury appearance and the presence of any preexisting maxillofacial problems such as congenital telecanthus, hypertelorism, apertognathia, prognathism, retrognathism, and nasal deviation.

More on Facial Trauma, Management of Panfacial Fractures

Overview: Facial Trauma, Management of Panfacial Fractures
Workup: Facial Trauma, Management of Panfacial Fractures
Treatment: Facial Trauma, Management of Panfacial Fractures
Follow-up: Facial Trauma, Management of Panfacial Fractures
Multimedia: Facial Trauma, Management of Panfacial Fractures
References
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References

  1. Wenig BL. Management of panfacial fractures. Otolaryngol Clin North Am. Feb 1991;24(1):93-101. [Medline].

  2. Follmar KE, Debruijn M, Baccarani A, et al. Concomitant injuries in patients with panfacial fractures. J Trauma. Oct 2007;63(4):831-5. [Medline].

  3. Erdmann D, Follmar KE, Debruijn M, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. Apr 2008;60(4):398-403. [Medline].

  4. Caron G, Paquin R, Lessard MR, et al. Submental endotracheal intubation: an alternative to tracheotomy in patients with midfacial and panfacial fractures. J Trauma. Feb 2000;48(2):235-40. [Medline].

  5. Stoll P, Galli C, Wachter R, Bahr W. Submandibular endotracheal intubation in panfacial fractures. J Clin Anesth. Jan-Feb 1994;6(1):83-6. [Medline].

  6. Babu I, Sagtani A, Jain N, Bawa SN. Submental tracheal intubation in a case of panfacial trauma. Kathmandu Univ Med J (KUMJ). Jan-Mar 2008;6(1):102-4. [Medline].

  7. Berardo N, Leban SG, Williams FA. A comparison of radiographic treatment methods for evaluation of the orbit. J Oral Maxillofac Surg. Oct 1988;46(10):844-9. [Medline].

  8. DeMarino DP, Steiner E, Poster RB, et al. Three-dimensional computed tomography in maxillofacial trauma. Arch Otolaryngol Head Neck Surg. Feb 1986;112(2):146-50. [Medline].

  9. Gillespie JE, Quayle AA, Barker G, Isherwood I. Three-dimensional CT reformations in the assessment of congenital and traumatic cranio-facial deformities. Br J Oral Maxillofac Surg. Apr 1987;25(2):171-7. [Medline].

  10. Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg. Feb 1983;41(2):89-98. [Medline].

  11. Kelly KJ, Manson PN, Vander Kolk CA, et al. Sequencing LeFort fracture treatment (Organization of treatment for a panfacial fracture). J Craniofac Surg. Oct 1990;1(4):168-78. [Medline].

  12. Tang W, Feng F, Long J, et al. Sequential surgical treatment for panfacial fractures and significance of biological osteosynthesis. Dent Traumatol. Apr 2009;25(2):171-5. [Medline].

  13. Irby WB. Facial Trauma and Concomitant Problems: Evaluation and Treatment. 2nd ed. St. Louis, Mo: CV Mosby; 1979.

  14. Tullio A, Sesenna E. Role of surgical reduction of condylar fractures in the management of panfacial fractures. Br J Oral Maxillofac Surg. Oct 2000;38(5):472-6. [Medline].

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Further Reading

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Keywords

facial trauma, panfacial fractures, facial fracture, plate and screw fixation, plate-and-screw fixation, facial trauma pictures, facial fracture pictures, facial fracture treatment, facial fracture repair, rigid fixation, midface injury, mid-face injury, midface reconstruction, mid-face reconstruction, panfacial injury, complex maxillofacial injury, panfacial trauma, facial fracture, face fracture, maxillofacial surgery, maxillofacial reconstruction, maxillofacial repair, maxillofacial injury, maxillomandibular fixation, MMF, panfacial fracture, facial trauma, facial fracture management

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Contributor Information and Disclosures

Author

Kris S Moe, MD, FACS, Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine; Clinical Associate Professor of Surgery, Division of Head and Neck Surgery, University of California, San Diego
Kris S Moe, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Society for Head and Neck Surgery, and North American Skull Base Society
Disclosure: Nothing to disclose.

Medical Editor

James F Thornton, MD, Assistant Professor, Department of Plastic and Reconstructive Surgery, University of Texas Southwestern
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
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