Management of Panfacial Fractures Workup

Updated: Nov 02, 2018
  • Author: Kris S Moe, MD, FACS; Chief Editor: Deepak Narayan, MD, FRCS  more...
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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. [12]

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. See the image below.

Axial view demonstrating increased zygomatic width 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. See the images below.

Coronal view of patient with panfacial fractures f Coronal view of patient with panfacial fractures from facial trauma.
Coronal view demonstrating cant of maxilla and man 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. [13, 14] They can aid in visualization and treatment planning of the bony injuries. [15] See the image below.

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

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