38 Facial Fractures and Swelling • Condyle 36% • Body 21% • Angle 20% • Symphysis 14% • Alveolar process 3% • Ramus 3% • Coronoid process 2% • Bones involved: • Le Fort I • Le Fort II • Le Fort III • Usually due to road traffic accidents • Fracture/damage involving frontonasal recess likely to cause stenosis • Damaged frontal sinus mucosa has a propensity for subepithelial fibrosis with a tendency to cyst formation • Mucoceles and mucopyoceles can result—bone erosion possible • Classifications: – Anterior wall – Posterior wall – Nasofrontal recess – “Through and through” – Linear—no operative intervention required – Displaced – Compound – “Missing bone”
38.1 Mandibular Fractures
38.2 Maxillary (Le Fort) Fractures (Fig. 38.1)
Maxilla
Sphenoid
Vomer
Ethmoid
Palatine bones
Zygoma
Nasal bones
Floor of nose
Lower one-third of maxilla
Palate
Pterygoid plates
Across nasal bony superstructure and frontal process of maxilla
Across face of anterior maxilla
Across orbital floor (inc. infra-orbital foramen)
Lateral wall of maxilla extending to pterygoid plates
Lateral fracture extending across orbital floor into lateral orbit through zygoma
Zygoma will move during palpation of palate
38.3 Frontal Sinus Fractures
Structures involved:
Type:
Depressed fractures require elevation of fragments and excision of mucosa trapped between fragments—bicoronal or butterfly flap
Displaced posterior wall fractures—osteoplastic flap and fat obliteration
Through and through fractures usually require a cranialization procedure at the time of anterior craniotomy—all mucosa is removed and frontonasal recesses plugged with temporalis fascia
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