Facial Trauma and Reconstruction
Core concepts
Understand the Le Fort classification, zygomaticomaxillary complex fracture patterns, orbital floor blowout mechanics, mandibular fracture zones and the course of the inferior alveolar nerve, and the sequencing of airway, hemorrhage control, and vision assessment. Know when to observe versus fixate, and the role of CT imaging.
Traps in questions
- Missing an orbital compartment syndrome or retrobulbar hematoma; questions may present decreasing vision after repair and test emergent lateral canthotomy.
- Confusing Le Fort I, II, and III levels; Le Fort I is the low transverse maxillary fracture, II is pyramidal, III is craniofacial disjunction.
- Forgetting that pediatric mandible fractures may be managed conservatively because of developing dentition.
- Overlooking associated cervical spine injury in high-energy facial trauma.
Rule of thumb
In any periorbital trauma with visual compromise and a tense orbit, decompress first and image later.
Worked example
A patient has malar flattening, diplopia, and a step-off at the infraorbital rim. The question asks the next best step. The rule: assess vision and globe integrity first, then obtain CT to define zygomaticomaxillary complex displacement; definitive open reduction and internal fixation follows once vision is safe. Choosing imaging before addressing a threatened globe is the classic wrong answer.