Minor maxillary displacement and malocclusion and low mobility of fractured segment are the indications of closed treatment. The decision to choose whether the open or closed technique in Le Fort fractures is dependent on the mobility of the maxilla and severity of maxillary displacement results in malocclusion. When the patient is stable, facial examination to detect the mid-face fractures is executed as follow. According to the possibility of spinal injuries in facial trauma patients stabilizing the cervical spine by a rigid collar is necessary until the spinal injury is ruled out.Īfter providing a secure airway, ATLS protocol can continued. The incidence rate of cervical spine trauma in pediatric facial fracture cases is almost 3.5% whilst this number is much higher in adult trauma patients. It is important to keep the airway open in mid-face fractures because there is always the potential of airway obstruction due to displacement of bones or severe bleeding in such cases.Ĭervical spine injuries are common in facial fractures. Intubation to secure the airway in instable mid-face fractures is the next step that should be considered in emergency patients. Packing should be used to control acute bleeding. Removal of fractured teeth, clots, and loose dental crowns or dentures is important to open the oral airway. Hemorrhage and secretions may obstruct the oropharynx and nasopharynx. Airway obstruction should be evaluated as soon as possible since the mid-face is the beginning of the respiratory pathway. This chapter aims to present a comprehensive review of mid-face fractures types’ diagnosis and management.Īdvanced trauma life support (ATLS) is the first step that should be applied in emergency cases. Esthetic disfiguring trauma changes the whole mid-facial compartments. Quality of life of the patients is influenced following unsuccessful management of mid-face fractures which lead to permanent functional problems. The treatment of mid-face fractures is complex due to the physiology and anatomy of mid-facial subunits. Diagnosis of the types of mid-face fractures is the first and basic step in management of mid-face trauma. Understanding the principles of mid-facial repair is the key to optimize the outcome.ĭiagnosing mid-face fractures is sometimes very difficult in emergency cases. The mid-face consists of vertical, horizontal, and sagittal pillars. The mid-face skeleton is important in providing a functional unit for respiratory, olfactory, vision, and digestive systems. The importance of mid-face is clear in function and esthetics. The other causes of facial fractures including mid-face trauma indicated in the literature are assaults, falls, sport injuries, and anima attacks. Motor vehicle accidents seem to be the first cause of mid-face fractures all around the word. Facial fractures are detected in almost 5–10% of trauma patients. Mid-face fractures are common in different populations.
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