AAO-HNSF Primary Care Otolaryngology Handbook

MAXILLOFACIAL TRAUMA

cosmetic issues, as the malar eminence (classically known as the cheekbone) may be displaced or rotated. If the zygomatic arch (technically not part of the zygoma but worth mentioning here) is fractured medi- ally, the displaced bone may compress the underlying temporalis muscle, resulting in trismus (inability to open the mouth widely). Tripod refers to the above three attachment points. Tetrapod refers to same area of frac- tures but has four fractured attachment points, as the maxillary bone is divided into two attachment points: inferior orbital rim and zygomaticomaxillary suture. Orbital Fractures Depending on the mechanism and vector of the trauma, orbital trauma consists of orbital floor fractures, orbital lateral wall/medial wall fractures, or simple orbital rim fractures (Figure 11.10). The biggest concern is the impact of the trauma on visual acuity, restricted eye movement, and globe position within the fractured orbit. Ophthal- mology consultation is considered manda- tory, especially if the patient has any concerning signs or symptoms on history and physical exam. Mandible Fractures

Figure 11.8. Le Fort III fracture. This trauma patient has obvious bilateral Le Fort III fractures, along with a small minimally displaced Le Fort II fracture on the right and left.

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Figure 11.9. Displaced tetrapod fracture showing a floating zygoma as all four limbs of attachment are fractured and displaced.

Trauma to the lower third of the face will involve the mandible. Most mandibular fractures cause functional issues. First, there may be dental damage (chipped dentition, avulsed teeth, fractured tooth roots, etc.), which needs to be documented accurately. Oral surgery or dentistry should be involved in any dental trauma. Second, the patient may complain of malocclusion (premature contact of the molars, open bite, or crossbite). Third, chewing may cause instability of the mandible. Because the mandible is constructed as an arch or semicircle, there should be a high index of suspicion for at least two separate fractures of the mandibular arch.

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