Facial Fractures Treatment & Management

  • Author: Timothy J Rupp, MD, FACEP, FAAEM; Chief Editor: Craig C Young, MD   more...
 
Updated: Sep 12, 2011
 

Acute Phase

Medical Issues/Complications

  • Frontal fracture: Repair of the anterior wall may be delayed, but posterior wall fractures require immediate neurosurgical evaluation. The decision regarding whether prophylaxis with antibiotics is needed should be left to the consulting surgeon.
  • Orbital fracture: The initial treatment is generally supportive, including head elevation, ice, and analgesics. The indications for surgical repair are controversial and may include diplopia that persists 2 weeks after the injury, large fractures, and enophthalmos. Orbital fractures that result in inferior rectus muscle entrapment, inferior orbital nerve entrapment, enophthalmus, or orbital dystopia may result in both cosmetic and functional impairment and should be referred to a specialist (ie, ophthalmologist, oral-maxillofacial surgeon, or plastic surgeon) within 24 hours to insure prompt resolution.[12]
  • Nasal fracture: An angulated nasal fracture can be reduced by exerting firm, quick pressure with the thumbs toward the midline or by inserting a soft probe in the nares to elevate the depressed or deviated septum into anatomic position.[6] Ongoing management of these injuries consists of control of epistaxis and supportive care with analgesics. Operative repair is best performed early, within 1-2 hours following the injury, or in 10-14 days following the injury once the swelling and edema has receded. Any open wounds require antibiotics.
  • Zygomatic/zygomaticomaxillary fracture: Open reduction and internal fixation to restore the normal contour is the standard of care.
  • Maxillary (Le Fort) fracture: Open reduction with internal fixation is the standard. If CSF rhinorrhea is present, a neurosurgeon should be consulted. Prophylactic antibiotics are warranted if the fracture extends through the tooth-bearing region or through the nasal or sinus mucosa.
  • Mandibular fracture: Most cases require admission with fixation. These fractures often require antibiotics because of their location in the tooth-bearing region. Penicillin or clindamycin are acceptable choices.

Consultations

Once a fracture has been identified, an appropriate surgeon or specialist (ie, plastic surgeon; ophthalmologist; ear, nose, and throat specialist; oral-maxillofacial surgeon; or neurosurgeon) provides the definitive care.

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Timothy J Rupp, MD, FACEP, FAAEM  Associate Medical Director, Physicians Emergency Care Associates, Methodist Health System; Clinical Physician, Children's Medical Center of Dallas and Children's Medical Center at Legacy, Plano; Clincal Associate Professor, University of Texas Southwestern Medical Center at Dallas

Timothy J Rupp, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Steven J Karageanes, DO  Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System

Steven J Karageanes, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Hwang K, You SH, Lee HS. Outcome analysis of sports-related multiple facial fractures. J Craniofac Surg. May 2009;20(3):825-9. [Medline].

  2. Costello BJ, Papadopoulos H, Ruiz R. Pediatric craniomaxillofacial trauma. Clin Pediatr Emerg Med. 2005;6(1):32-40.

  3. Boden BP, Tacchetti R, Mueller FO. Catastrophic injuries in high school and college baseball players. Am J Sports Med. Jul-Aug 2004;32(5):1189-96. [Medline].

  4. Schulz RC. Facial Injuries. 2nd ed. Chicago, Ill: Yearbook Medical Publishers, Inc; 1977.

  5. Reehal P. Facial injury in sport. Curr Sports Med Rep. Jan-Feb 2010;9(1):27-34. [Medline].

  6. Romeo SJ, Hawley CJ, Romeo MW, Romeo JP. Facial injuries in sports: a team physician's guide to diagnosis and treatment. Phys Sportsmed. Apr 2005;33(4):45-53. [Medline]. [Full Text].

  7. Tanaka N, Hayashi S, Suzuki K, et al. [Clinical study of maxillofacial fractures sustained during sports and games] [Japanese]. Kokubyo Gakkai Zasshi. Sep 1992;59(3):571-7. [Medline].

  8. Laskin DM. Protecting the faces of America. J Oral Maxillofac Surg. Apr 2000;58(4):363. [Medline].

  9. Iida S, Kogo M, Sugiura T, Mima T, Matsuya T. Retrospective analysis of 1502 patients with facial fractures. Int J Oral Maxillofac Surg. Aug 2001;30(4):286-90. [Medline].

  10. Bak MJ, Doerr TD. Craniomaxillofacial fractures during recreational baseball and softball. J Oral Maxillofac Surg. Oct 2004;62(10):1209-12. [Medline].

  11. Reyes Mendez D, Lapointe A. Nasal trauma and fractures in children. UpToDate [serial online]. May 2007;Accessed September 14, 2007. Available at www.UpToDate.com.

  12. Neuman MI, Bachur RG. Orbital fractures. UpToDate [serial online]. September 2006;Accessed September 14, 2007. Available at www.UpToDate.com.

  13. Schwab RA, Genners K, Robinson WA. Clinical predictors of mandibular fractures. Am J Emerg Med. May 1998;16(3):304-5. [Medline].

  14. Roccia F, Diaspro A, Nasi A, Berrone S. Management of sport-related maxillofacial injuries. J Craniofac Surg. Mar 2008;19(2):377-82. [Medline].

  15. Tesini DA, Soporowski NJ. Epidemiology of orofacial sports-related injuries. Dent Clin North Am. Jan 2000;44(1):1-18, v. [Medline].

  16. Baker SM, Hurwitz JJ. Sports and industrial ophthalmology: management of orbital and ocular adnexal trauma. Ophthalmol Clin North Am. 1999;12:435-55.

  17. Christensen GR. Eye injuries in sports: evaluation, management, and prevention. In: Mellion MB, Walsh WM, Shelton GL, eds. The Team Physician's Handbook. 2nd ed. Philadelphia, Pa: Hanley & Belfus, Inc; 1997:407-25.

  18. Dominguez S. Maxillofacial trauma. In: Markovchick VJ, Pons PT, eds. Emergency Medicine Secrets. 2nd ed. Philadelphia, Pa: Hanley & Belfus, Inc; 1999:404-7.

  19. Ellis E 3rd, Scott K. Assessment of patients with facial fractures. Emerg Med Clin North Am. Aug 2000;18(3):411-48, vi. [Medline].

  20. Hendler BH. Maxillofacial Trauma. In: Rosen P, Barken R, eds. Emergency Medicine Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998:1098-103.

  21. Kaufman BR, Heckler FR. Sports-related facial injuries. Clin Sports Med. Jul 1997;16(3):543-62. [Medline].

  22. Thomas SH. Maxillofacial injuries. In: Harwood-Nuss AL, ed. The Clinical Practice of Emergency Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996:408-18.

  23. Tu HK, Davis LF, Nique TA. Maxillofacial injuries. In: The Team Physician's Handbook. 2nd ed. Philadelphia, Pa: Hanley & Belfus, Inc; 1997:426-37.

 
Previous
Next
 
The bony walls of the orbit.
Le Fort fractures.
Mandibular fractures.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.