#EMConf: Facial Fractures

Orbital Fractures

Orbital Blowout Fracture:

  • Involves medial and inferior walls
  • Need to check visual acuity and sensation, extraocular movements
  • Higher risk of ocular injury compared to non-pure orbital fractures (because in non-pure, orbital rim is involved, meaning the rim is taking some of the impact, vs. pure blowout, the eyeball itself is taking most of the impact, causing the wall/floor fractures)
  • Always evaluate for retrobulbar hematoma!! Evaluate for proptosis, decreased visual acuity, elevated intraocular pressure (concerned if >40mmHg), afferent pupillary defect
    • *Management = lateral canthotomy

Entrapment: Limitation of upward gaze from entrapment of inferior rectus muscle, binocular diplopia (vs monocular diplopia suggests lens dislocation); can have infraorbital anesthesia.

Management of Orbital Fractures:

  • PO amox-clav (Augmentin) to treat sinus pathogens
  • Decongestants
  • Avoid nose blowing
  • Facial consult before discharge 

Naso-orbito-ethmoid fractures: Usually require admission and facial surgery, sometimes neurosurgery consult because they are often accompanied by injury to lacrimal duct, dural tears, and traumatic brain injury

Tripod fracture: Zygomaticomaxillary tripod fracture (malar flattening of cheek)

  • Zygomatic arch
  • Maxilla (including sinuses)
  • Lateral orbit

LeFort Fractures:

Mandibular Fractures:

  • Management: All except isolated coronoid fracture will need repair, but not necessarily emergent
    • Closed fracture: nondisplaced; soft/liquid diet with urgent outpatient follow up
    • Open fractures: emergent consult, antibiotics (penicillin G, clindamycin), admit