AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 11

Because of the various muscles of mastication and its vectors of pull in relation to the frac- ture pattern, each mandible fracture can be classified as favorable or unfavorable . A favorable fracture will result in the muscles pulling the fractured bone together, and an unfavorable fracture will result in the fractured bone being pulled apart by the overall vector of the mastication muscles. This will then dictate if surgery is needed and what type of surgery is recommended. If a patient has a favorable fracture with reasonable post- trauma occlusion and is very compliant with a liquid/no-chew diet, no surgery is needed and the patient may have a decent chance of recovery with adequate bone healing. If the patient has a favorable fracture but cannot be trusted to follow a no-chew diet or if the patient has an unfavorable fracture(s), then surgery is indicated.

Figure 11.10. Isolated right orbital floor fracture (orbital floor blowout fracture). Patient was punched in his eye during a mugging attempt. The fracture is medial to the infraorbital nerve and inferior-medial to the inferior rectus muscle. There is some herniation of periorbital fat into the right maxillary sinus. If the inferior rectus muscle herniates through the orbital floor defect, this entrapment will cause limited upward gaze and diplopia.

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Consideration for Facial Skeleton Repair When determining candidacy for facial fracture repair, the surgery is usually elective , but the fractures should be repaired within a week of the trauma for optimum results. Ideally, the cervical spine should be cleared by the trauma team, so the surgeon can flex, extend, and rotate the neck as needed during the surgery. The surgeon will need to keep in mind the principles of restoring function and form when completing the operative repair. By achieving adequate fracture reduction and solid fixation (usually with titanium plates and screws), form and function will be restored. The operative principles are beyond the scope of this chapter.

Primary Care Otolaryngology