Maxillofacial Injuries Classification

Maxillofacial Injury

Maxillofacial injuries Classification

• Fracture of the lower third which comprises of mandible
• Fracture of the middle third which comprises of maxilla, zygoma, and nose
• Fracture of the upper third of the face involving part of the orbit and frontal bones.

Maxillofacial injuries Soft tissue injuries

• Lacerations, contusions, cut wounds, etc.
• Eyelid injuries with black eyes
• Facial nerve injury: Primary repair is required
• Parotid duct injury: Primary Anastomosis of the injured duct is done, with fie polyethylene cannula kept as a stent inside the duct which is removed in 14 days.
• Lacrimal apparatus injuries: Here the duct is sutured with fine nylon thread in canaliculus which is kept for three months.

Injuries To Facial Bones

• Fracture nose: Nasal bones are the most commonly injured bones in the face.
  • The patient presents with pain and swelling in the nose with deviation and displacement.
  • Here reduction of the fractured nasal bones and nasal septum under general anesthesia is done.
  • Later position is maintained by nasal packs from inside (which is removed in 7 days) and by a nasal plaster from outside (which will be kept for 14 days).
  • The procedure is done using Walsham and Asch forceps.
• Injuries to the maxilla
• Zygomatic bone injuries.
• Mandibular bone fracture and mandibular dislocation.
• Orbital bone fracture: Presents with diplopia, enophthalmos, and sensory loss in the area of the infraorbital nerve.
• Infraorbital ecchymosis of the orbit is called the Panda sign.

Maxillofacial Injuries Clinical Features

• Localized swelling due to hematoma
• Facial edema
• Bleeding with open wounds
• Asymmetry which is clinically confirmed by observing supraorbital ridges, nasal bridge
• Localized tenderness
• Step deformity
• Trismus
• Diplopia
• Features of associated injuries such as intracranial, abdominal or thoracic injuries.

Maxillofacial injuries Investigations

• X-ray face
• CT scan of head and jaw

Maxillofacial injuries Management

• As the initial assessment, evaluation, and management of life-threatening injury get completed compound fracture should be treated in the following manner, i.e.

• Hemostasis should be achieved.
• For Type I and Type II compound fractures cephazolin or clindamycin are the choice of drugs while for Type III compound fractures, aminoglycoside is given.
• Tetanus vaccination should be given.
• Irrigation, as well as debridement of the wound, should be carried out immediately.
• In cases with Type II and Type III compound fractures serial irrigation and debridement are recommended for every 24 to 48 hours till a clean surgical wound is confirmed. Close the wound when it gets clean fully.
• Management of open fractures depends on their type and site. Later on wound is stabilized temporarily or definitively.
• If coverage of soft tissue after injury is not proper soft tissue transfer or free flAp is given to the patient when fracture is treated.