A softball to the eye, a tumble to the floor, a gunshot wound while hunting, or a wayward fist at a local watering hole all might send a patient to the trauma center with an orbital or ocular injury. In patients with facial fractures, 20 to 25 percent include orbital involvement at some level. Of this group, over 80 percent will include ocular trauma.
A facial fracture is a broken bone in the face. The face has a complex bone structure. The facial skeleton consists of the frontal bone foreheadzygomas cheekbonesorbital bones eye socketsnasal bones, maxillary bones upper jaw and mandible lower jaw.
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A n year-old man presented to the ED with facial trauma due to a mechanical fall after losing his balance on uneven pavement and hitting the right side of his face. Physical examination revealed an ecchymosis inferior to the right eye and tenderness to palpation at the right maxilla and bilateral nasolabial folds. Maxillofacial computed tomography CT was ordered for further evaluation; representative images are presented above Figure 1a and 1b. A noncontrast CT of the maxillofacial bones demonstrated acute fractures through the bilateral pterygoid plates white arrows, Figure 2a.
Facial fractures are fractures broken bones of the face and mouth. They commonly include fractures of the nose nasalcheekbones zygomasurrounds to the eyes orbit and upper maxilla and lower mandible jaws. If you have a facial fracture, the oral and maxillofacial team will usually want to check that you don't have other fractures of or injuries to the head or neck and if you have been knocked unconscious.
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Howard A. Our faces play a role in almost every part of our lives. The structure and components of the face are involved in our ability to eat, speak, and see, and often are the features first noticed when we meet someone.
Airway and circulation should have the highest priority. This is followed by an assessment of the patient neurological, visual, and cervical spine status. To assess the individual fracture pattern in midfacial fractures the patient medical history should be considered, if possible. This could reveal preexisting occlusal deformities or ophthalmologic pathologies independent of the injury.
In cases of facial trauma, nasal fractures account for approximately 40 percent of bone injuries. Treatment in the primary care setting begins with evaluating the injury, taking an accurate history of the situation in which the injury occurred, and ascertaining how the face and nose appeared and functioned before the injury occurred. Serious injuries should be treated, then nasal inspection and palpation may be performed to assess for airway patency, mucosal laceration, and septal deformity.