$injury le fort fracture$

$injury le fort fracture$

The nasal bones are easily fractured due to them being broad and flat, but proximal nasal bone fracture may be accompanied by fractures of adjacent bones which may lead to additional complications such as: In blunt injuries involving the eye, the globe is more resistant to perforation than the bony orbit is to fracture. In an orbital blow-out fracture, the pressure from a direct blow involving the relatively tough globe is transmitted downwards, fracturing the floor of the orbit, and often results in herniation of intraocular contents into the maxillary sinus. ZMC fractures nearly always incorporate some degree of orbital fracture which become clinically relevant to the EM physician when they involve the orbital floor. The zygoma and maxilla form the greater part of the medial, inferior and lateral orbital margins as well as almost all of the orbital floor. The bony orbit is composed of thickened orbital rims (margins) but relatively thin inner walls. The image illustrates the mechanism of an orbital blow-out fracture. The nerve’s location makes it very vulnerable to both direct injury, and involvement in ZMC fractures. Immediately below the infraorbital margin of the maxilla lies the infraorbital foramen, through which passes the infraorbital nerve (part of the maxillary division of the trigeminal nerve). Temporalis muscle (highlighted) running under the zygomatic arch

$injury le fort fracture$

For clarity the emergency physician (EP) should refer to injuries either to the zygomatic arch or the zygomaticomaxillary complex (ZMC). Other important midface fractures which may be differentiated clinically in the ED are:Ĭonfusingly, many terms exist for fractures to the zygoma and surrounding bones. Which injuries are not covered by these terms and can be separately identified in the ED? those fractures mainly involving the zygoma, maxilla and/or the orbital rim

$injury le fort fracture$

Zygomaticomaxillary complex (ZMC) injuries, i.e.fractures predominantly affecting the zygomatic arch, or How can we avoid confusion when describing these injuries in the ED?įor clinical clarity in the ED, it is suggested that the majority of injuries involving the zygoma and surrounding bones are either referred to as: Whilst it is important to delineate the individual components of a facial injury, in most instances this can only be done accurately by CT scan at a later stage. The sutures connecting the zygoma to adjacent bones may also be disrupted. Injuries to the zygoma and the surrounding facial bones are confusingly referred to by a number of different terms including:Īll these terms refer to injuries of the zygoma with, in most cases, involvement of the maxilla or temporal bone. Īlthough facial injuries are one of the most common problems seen in the ED, interpretation of facial x rays remains a frequent cause of diagnostic error. While computed tomography is used frequently in trauma, plain x-rays remain relevant in the initial evaluation of potential isolated facial fractures.įacial x-rays were the most commonly misinterpreted radiographs in one study of EM residents in the USA, leading to the most clinically significant errors from all x-ray misinterpretation. Īlthough emergency medicine (EM) physicians encounter large numbers of patients with facial injuries, interpretation of facial x-rays, particularly injuries involving the zygoma, are a common source of diagnostic error in the ED. Of all facial fractures, nasal fracture is by far the most common seen in the ED. Not surprisingly, males outnumber females for facial fractures by a ratio of 2:1. In the 15-50 age group, the most common cause of facial fracture is interpersonal violence, at all other ages it is falls. Anyone who has ever worked in an emergency department (ED) on a Friday night knows that facial injuries are a common presentation.

$injury le fort fracture$

Injury le fort fracture