Maxillary Fractures  LeFort Fractures  I – Transverse  II – Pyramidal  III – Craniofacial Dysjunction  Signs  Facial Swelling, malocclusion, midface instability, V 2 numbness, facial elongation/flattening, bleeding/epistaxis

Mandible Fractures  Multiple # patterns  All tooth bearing #s are “open”  Assc. Dental injuries / C-spine injuries  Signs  Facial Swelling  Malocclusion  Intraoral lac’ns  V 3 numbness,

Mandible Fractures  All “open” fractures should be treated in 48 hrs  Perioperative Abx  Goal is to restore normal occlusion

Frontal Sinus Fractures  Uncommon Injury  Assc. with Intracranial & Orbital injury  Signs  Facial Swelling  CSF Rhinorrhea  V 1 numbness

Indications for Referral  Intracranial, C-Spine or Ocular Injuries  Complex soft-tissue injuries (Lip, Eyelid/Eyebrow, Nose, Ear, other)  Facial nerve lac’n (prox. to lat. canthus)  Parotid duct or Lacrimal injuries  Dental Injuries

 Nasal fractures = reduce or early phone contact to plan for closed reduction  Open fractures = clean, close and refer as per closed facial fractures  Blowout fractures and zygoma fractures = within one week for appropriate management plans Indications for Referral

 Open mandible fractures = antibiotics and early referral  Closed mandible fractures = early phone referral in order to plan for treatment Indications for Referral

Summary  Stabilize patient & rule out life- or limb- threatening injuries  Methodical Clinical Exam, Hx & Imaging  Manage soft-tissue Injuries as appropriate  Refer for treatment of complex injuries