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Resident Manual of Trauma to the Face, Head, and Neck
4
Chapter 4: Midfacial Trauma
........................................................................ 74
I.
Maxillary and Orbital (and Zygomatic) Fractures
...................... 74
A. Dental Terminology........................................................................ 74
1. Maxillae and Mandible............................................................ 74
B. Midfacial Anatomy......................................................................... 75
1. Strong Areas of the Facial Bone.............................................76
2. Maxillae.......................................................................................76
3. Nasal Bones ...............................................................................77
4. Orbits ..........................................................................................77
C. Midfacial Fractures.........................................................................78
1. Le Fort Series of Fractures ......................................................78
2. Zygomatic Fractures................................................................ 80
3. Orbital Fractures....................................................................... 80
D. Diagnosis of Midfacial Trauma................................................... 80
1. Assessment of Vision ............................................................ 80
2. Assessment of Other Nerves .................................................81
3. Le Fort Fractures ........................................................................81
4. CT Scan ........................................................................................81
E. Considerations for Repair of Midfacial Trauma........................81
1. Orbital Fractures.........................................................................81
2. Zygomatic Fractures.................................................................82
3. Maxillary Fractures...................................................................82
F. Approaches to Repairing Midfacial Trauma ............................82
1. Orbital Fractures........................................................................82
2. Zygomatic Fractures.................................................................86
3. Maxillary Fractures...................................................................87
G. Fracture Reduction and Repair.....................................................87
1. Zygomatic Fractures ................................................................87
2. Maxillary and Extended Maxillary Fractures......................88
3. Blowout Fractures of the Orbits.............................................89
H. Complications...................................................................................89
1. Inadequate Reduction .............................................................89
2. Imprecise Reconstruction of the Orbit................................89
3. Globe Malposition ...................................................................89
4. Eyelid Malpositions ................................................................. 90
5. Reduced Vision and Blindness.............................................. 90
6. Scars and Hair Loss ................................................................. 90
7. Nonunion ................................................................................... 90
8. Dental Injury ............................................................................. 90
9. Cerebrospinal Fluid Leaks...................................................... 90
II. Nasal Bone Fractures
...........................................................................91
A. Introduction.......................................................................................91