LITERATURE

MAXILLOFACIAL INJURY
 BACKGROUND

• Maxillofacial injury is physical trauma that affect

on soft tissues and bones in facial.
• Several emergencies condition due to
Maxillofacial injury are:
1. Airway obstruction
2. Massive bleeding
3. Soft tissue injury
4. Bone fragmen dismissed
5. Severe pain
 BACKGROUND

• Traffic accidents are the most common causes,

approx. About 72%,
• Most injury can be checked by physical
examination
• Emergencies treatment given by general
practicers consist of Basic Life Support and
Advanced Trauma Life Support
• Early assessment and intervention can
significantly reduce morbidity and mortality and
avoid complex reconstruction later
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Nasal Reg.

Jaw Reg.

Figure 1. Anatomycal View of Maxillofacial

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- Lacrimal bones
Nasal Reg. - Nasal bones
- Conchae
- Nasal Septum

Jaw Reg.
- Maxillar bone
- Zygomatic bone
- Palatal bone
- Mandibular bone
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Definition
• Fractures of the facial skeleton are common
reasons for presentation to Emergency
Department.
• Trauma to the maxillofacial region can lead to
airway obstruction, intracranial injuries, loss
of vision or long term cosmetic and functional
deficits
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Etiology

• Recreational activities and contact sports are

frequently implicated as are pedestrian
• Motorcycle and motor-vehicle accidents.
• Interpersonal violence is also common, often
related to alcohol and illicit drug use
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The Classification of Maxillofacial injury

Nasal Complex fractures

Zygoma complex fractures

Dentoalveolar fractures

Maxillar fractures

Mandibular fractures
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Nasal Complex
fractures

• Fractures of the nose area usually involve the

nasal septum. Sometimes cartilage septum
almost pulled out of its groove on vomer and
perpendicular plate and kribriform ethmoid plate
may also be exposed fracture
 Zigoma fracture is
Zygomaticomaxillary one of the most
fracture frequent midfacial
fracture occurs,
usually common in
trauma involving
Midfacial fracture Le Fort Fracture the middle third of
the face, this is
because the
position zigoma
Nasoorbitoethmoid
Fracture
more prominent in
the surrounding
area.
 Fig
-Anatomy of the zygoma.
1-5, Temporal, frontal, maxillary,
• orbital, and infraorbital processes
of zygoma;
6. frontal bone;
7, maxillary bone;
8, temporal bone;
9, greater wing of sphenoid bone;
10, zygomatic process of temporal
bone;
11, zygomatic temporal suture;
12, zygomatic process of maxilla;
13, zygomatic maxillary suture;
14, orbital surface of maxilla;
15, infraorbital foramen
The muscles attached to bones zigoma.
 Etiology

Traffic
Blow
accident

Sport
Fights
injuries
 Fraktur
Zygomaticomaxilary
• Bottom wall of the orbita
• Suture Zigomaticofrontal
• Arch of the suture zigomatikotemporal
• Zigomatikomaksila lateral wall
• Suture Zigomatikosplenoid
• Medial orbital wall remains intact
 Diagnosis
Physical examination
Anamnesis • Inspection (frontal, lateral,
superior, and inferior )
• Chronological • Asimetric
trauma • Periorbital ecchymosis
• The direction • Subconjungtiva bleeding
and strength of • Eksophtalmus /
the trauma enophtalmus
• Diplopia
• reduced sensory nerve
Radiographic
examination

•Water’s view
•Submentovertex
view
•Caldwell view
•CT Scan
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Dentoalveolar
Fractures

• Dento-alveolar injury consists of fracture,

subluxation or displation of teeth (avulsion), with
or without an association with a fracture that
occurs in the alveoli, and may occur as a unified
clinical or join any other form of fracture
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Dentoalveolar Fractures

Figure 5. (Left): A step in the occlusal plane and ruptured gingival

(arrow) associated with a mandibular fracture. (Right): A sublingual
haematoma (arrow) can be an indicator of a mandibular fracture
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Maxillar fractures

• Fractures of maxillar bone, consist of three main

fractures:
- Le Fort I fractures
- Le Fort II fractures
- Le Fort III fractures
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Maxillar
fractures
• Le Fort I fractures
is a low transverse fracture that crosses the floor of
the nose, pyriform aperture, canine fossa, and
lateral wall from the maxilla, resulting in separation
of the palate from the maxilla

Memory Aid
Le Fort 1 is a floating palate
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Maxillar
fractures
• Le Fort II fractures
Crosses the nasal bones on the ascending process
of the maxilla and lacrimal bone and crosses the
orbital rim. Only the Le Fort II fracture violates the
orbital rim.
The Le Fort II fracture extends posteriorly to the
pterygoid plates at the base of the skull

Memory Aid
Le Fort II is a floating maxilla
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Maxillar
fractures
• Le Fort III fractures
Traverses the frontal process of the maxilla, the
lacrimal bone, the lamina papyracea, and the
orbital floor. This fracture often involves the posterior
plate of the ethmoid.
Because of their location, Le Fort III fractures are
associated with the highest rate of cerebrospinal
fluid (CSF) leaks
Memory Aid
Le Fort II is a floating face
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Maxillar
fractures

LF II LF III
LF I

Figure 3 Le Fort fracture configuration. LFI,II,III (left to

right)
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Mandibular
fractures

• Mandibular fractures can occur as a result of sports

activities, falls, motor vehicle accidents, and
interpersonal trauma.
• Clinical findings on mandibular fractures often
experience pain when chewing, and other symptoms
include numbness of the third division of the trigeminal
nerve
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Mandibular
fractures

Figure 4. Mandibular fractures