Head and Neck Spaces and Maxillofacial Trauma
This domain tests three-dimensional anatomy, trauma assessment, airway priorities and fixation principles.
Core rules
- Use ATLS priorities: airway, breathing, circulation, disability and exposure. Assume cervical spine injury until cleared.
- Le Fort I is a low maxillary fracture with mobile palate; II is pyramidal; III is craniofacial dysjunction. Mandible fractures include symphysis, parasymphysis, angle, body, ramus and condyle.
- Favorable versus unfavorable fractures depend on muscle pull and fracture line direction. Condylar fractures may be managed closed or open based on displacement, occlusion and patient factors.
- CT with fine cuts is standard for facial trauma; OPG is useful for the mandible; CBCT is selected for limited trauma.
- Fixation may be load-sharing or load-bearing. Miniplates, arch bars and maxillomandibular fixation restore occlusion. Restore occlusion first, then fixation.
- Soft-tissue injury requires tetanus assessment, antibiotics when indicated, primary repair and evaluation of the parotid duct and facial nerve.
Worked example
A patient has a parasymphysis fracture and malocclusion. Check both condyles because a second fracture is common. Reduce and fix the symphysis, then recheck occlusion; if the condyle is displaced, plan open or closed management.
Traps
Missing a second fracture; ignoring cervical spine risk; treating swelling before the airway; not checking occlusion; failing to document nerve function.