Facial Trauma

Orbit fractures: There are 2 types of orbit fractures: (1) those

that involve the orbital walls/rim and (2) so-called blowout

fractures. Blowout fractures may involve the orbital floor

(inferior blowout) or ethmoid (medial blowout), but the rim is

intact. Imaging should determine whether (1) there are other

orbital or facial fractures and (2) whether there is entrapment

of the inferior ± medial rectus muscles and fat.

Facial bone (Le Fort) fractures: There are 3 types of Le Fort

fractures. Le Fort I is a horizontal fracture through the maxilla

that involves the piriform aperture. Le Fort II is a pyramidal

fracture that involves the nasofrontal junction, infraorbital

rims, medial orbital walls, orbital floors, and the

zygomaticomaxillary suture lines.

Le Fort III, a.k.a. craniofacial separation, consists of nasofrontal

junction fractures that extend laterally through the orbital

walls and zygomatic arches.

All 3 Le Fort fractures involve the pterygoid plates and often

exhibit elements of > 1 type of facial bone fracture.

Zygomaticomaxillary fractures: The prominent position of

the zygomatic arch renders it susceptible to trauma. A

zygomaticomaxillary complex (ZMC) fracture, formerly

referred to as a "tripod fracture," has 4 involved articulations

and 5 distinct fractures.

Imaging in ZMC fractures should determine how

displaced/comminuted the fracture is, whether there is

involvement of the orbital floor/apex &/or lamina papyracea,

and how the lateral orbital wall is displaced.

Complex midfacial fracture: Complex midfacial fracture, or

"facial smash injury," consists of multiple facial fractures that

cannot be classified as 1 of the named patterns. It is important

to determine the posterior displacement of the midface, as

this is a highly cosmetically deforming injury. Associated

injuries to the orbit &/or skull face must be delineated in

detail.