What are the patterns of facial fractures?

From the Guidelines

Facial fractures typically occur in predictable patterns, with the most common structures involved being nasal bones, orbital floor, zygomaticomaxillary complex, maxillary sinuses, and mandibular ramus, in order of frequency. The patterns of facial fractures can vary depending on the cause of the injury, with motor vehicle collisions and recreational vehicle accidents more likely to result in fractures of the mandible and nasal bones, while penetrating trauma and assaults are more likely to produce midface and zygomatic fractures 1. Some key points to consider when evaluating facial fractures include:

• The mechanism of injury, such as motor vehicle collisions, falls, or assaults, which can influence the type and severity of fractures
• The presence of associated injuries, such as brain, cervical spine, or cerebrovascular injuries, which can impact treatment and outcomes
• The importance of diagnostic imaging, such as CT scans, in accurately diagnosing the full extent of facial trauma and guiding treatment decisions 1. Understanding these patterns and factors is crucial for proper diagnosis and treatment planning, as different fracture patterns require specific approaches to restore facial form and function. In clinical practice, it is essential to prioritize a thorough primary survey, including assessment of airway, breathing, and circulation, followed by a secondary survey of the face, including palpation, visual inspection, and diagnostic imaging, to ensure accurate diagnosis and effective treatment of facial fractures 1.

From the Research

Patterns of Facial Fractures

• Facial fractures can be classified based on anatomic location and pattern of comminution and displacement, with low, middle, or high energy patterns defined by the degree of segmentation and displacement in CT scans 2
• The mechanism of injury can influence the type and management of facial fractures, with nasal fractures being the most common injury sustained by all mechanisms, and motor vehicle collisions (MVCs) being most likely to cause nasal and malar/maxillary fractures 3
• Fracture patterns can vary by age, sex, race, and mechanism of injury, with operative intervention rates being highest for mandible fractures and lowest for orbit fractures 4
• The incidence of associated soft tissue injuries, such as hematoma and laceration, can vary depending on the type and location of the fracture, with hematoma being the most common associated soft tissue injury in mandibular trauma 5

Classification of Facial Fractures

• Facial fractures can be classified into different types, including:
  • Nasal fractures
  • Maxillary/malar fractures
  • Orbital fractures
  • Mandible fractures
• Each type of fracture can have different patterns of comminution and displacement, and may require different treatment approaches 2, 3, 4

Factors Influencing Fracture Patterns and Management

• Multiple factors can influence fracture patterns and management, including:
  • Age
  • Sex
  • Race
  • Mechanism of injury
  • Insurance status
  • Hospital characteristics
• These factors can affect the likelihood of operative intervention and the type of treatment approach used 3, 4