Radiologists’ interpretations of CT scans are important for planning surgery in patients with facial trauma. There are also specific terms to classify the location of mandibular and orbital fractures. It is essential to know the typical patterns and classifications of facial fractures, including those of the zygomaticomaxillary complex and naso-orbito-ethmoidal complex, because each pattern is often associated with particular functional and esthetic complications. Thus, imaging is critical for surgeons to understand which anatomic structures are involved so they can plan the surgical approach and intraoperative technique. ![]() In other patients like such with polytrauma is widely known that even that physical exam does not rule out fractures because of distracting injuries, obtundation, or facial swelling. ![]() Īlthough some authors affirm that appropriate physical examination of the face reliably rules out fractures in some patients (as low impact trauma ones) and some clinical variables are associated with facial fractures, physical examination alone cannot classify facial injuries. In all emergency department patients (those who require surgery and those who do not), closed nasal bone fractures are the most common, being found in 30.1% to 55.8%. The second and third most commonly fractured bones vary with the series, being the maxilla and orbit (39.8% each) in one series but the malar bone (15.2%) and maxilla (6.4%) in another. In patients who require surgery, the most commonly fractured bone is the mandible (41.6–75.2%). The most common causes of facial injury are assault (44–61%), traffic accidents (15.8%), and falls (15%). Most patients with facial trauma are male (56.8–92.8%), and the mean age in reported series ranges from 24.6 to 51.0 years. In these patients, major findings may go undetected due to multiple trauma, clinicians’ inability to perform a thorough physical examination, patients’ inability to cooperate, and pronounced facial swelling thus, facial injuries can be challenging for trauma surgeons. Many patients seen in emergency departments have facial trauma. It is essential to categorize fracture patterns and highlight features that may affect fracture management in radiology reports of facial trauma. Frontal sinus fractures that extend through the posterior sinus wall can create a communication with the anterior cranial fossa resulting in leakage of cerebrospinal fluid, intracranial bleeding. Orbital fractures can also result in injuries to the globe or infraorbital nerve. In orbital fractures, entrapment of the inferior rectus muscles can lead to diplopia, so it is important to assess its positioning and morphology. Severe comminution or angulation can lead to wide surgical exposure. Displaced fractures of the zygomaticomaxillary complex often widen the angle of the lateral orbital wall, resulting in increased orbital volume and sometimes in enophthalmos. The classification of naso-orbito-ethmoid depends on the extent of injury to the attachment of the medial canthal tendon, with possible complications like nasofrontal duct disruption. Conceptualized when low-speed trauma was predominant, the Le Fort classification system has become less relevant giving more importance on maxillary occlusion-bearing segments. These fractures are classified in three basic patterns that can be combined and associated with various complications. In Le Fort fractures, there is a breach between the pterygoid plates and the posterior maxilla. It has helped clinical management and surgical planning, so radiologists must communicate their findings to surgeons effectively. In patients with facial trauma, multidetector computed tomography is the first-choice imaging test because it can detect and characterize even small fractures and their associated complications quickly and accurately.
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