Facial fracture

Fronto-basal fractures
- Trauma to frontal bone or roof of nose
  - Car accidents
- Escher classification
  - Escher 1 – High fracture (forehead, calvaria)
  - Escher 2 – Central fracture (low forehead)
  - Escher 3 – Low fracture (along nasal cavity? – midface separated from skull base)
  - Escher 4 – latero-orbital fracture (above and lateral to orbit)
- Clinical features
  - CSF rhinorrhoea
  - Cranial nerve palsy
  - Raccoon eyes – haematoma around eyes
- Diagnosis
  - High-resolution CT
- Complications
  - Ascending infection -> meningitis, brain abscess
  - Vision loss
  - Oculomotor palsy
- Treatment
  - All fractures should be surgically treated
Maxillo-facial fractures
- Etiology
  - Car accident
  - Assault
  - Fall
- Le Fort classification
  - Le Fort 1 – separates maxilla from mid-face
  - Le Fort 2 – separates nasomaxillary complex (goes above nose)
  - Le Fort 3 – separates mid-face from skull
- Clinical features
  - Facial oedema
  - CSF rhinorrhoea
  - Epistaxis
  - Mobile maxilla
  - Hypoesthesia of infraorbital nerve
  - Raccoon eyes
- Treatment
  - Ensure airways
  - Facial reconstruction
Blowout fracture
- Isolated fracture of the orbital floor with herniation of orbital content into maxillary sinus
- Etiology
  - High-velocity blunt trauma to the eye
  - Punch
  - Tennis ball
- Clinical features
  - Periorbital pain, oedema, ecchymosis
  - Posteriorly depressed eye
  - Hypoesthesia of infraorbital nerve
  - Epistaxis
- Treatment
  - Urgent stabilization‎