Multiple facial bone fractures in a trauma patient


Maxillofacial injuries occur in approximately 16% of trauma patients1 with young males typically involved. The three most common causes of maxillofacial trauma are:

  1. Motor vehicle crashes
  2. Falls
  3. Assault/Interpersonal altercation

Frontal sinus fractures are seen in 5 to 15% of traumatic craniofacial fractures2. As with other craniofacial injury, it is associated with blunt trauma, particularly motor vehicle accidents. Interestingly, the incidence of frontal sinus fractures has decreased recently with the advent of airbag installation in motor vehicles. Nowadays, interpersonal altercation is the most common cause.

Over the last few decades, there has been an increasing tendency to manage frontal sinus fractures conservatively, either without surgery or with endoscopic sinus repair. Features which are indicative for surgery include:

  • A displaced anterior table injury
    • This can pose a cosmetic disfiguration if not surgically corrected
  • Severe posterior table injuries
    • This can cause CSF leak, post nasal drip, or entrapment of mucosa and the formation of mucocoeles
  • Compromised nasofrontal outflow tracts
    • This can also lead to mucocoele formation

Ethmoid fractures are relatively more uncommon, and are found in 5% of adult facial fractures3. Correct management of these fractures is imperative due to late complications, which are largely aesthetic in nature. This includes shortened palpebral fissures, telecanthus and enophthalmos, dystopia and saddle nasal deformity.

Orbital fractures are typically associated with other craniofacial injuries. Evaluation of orbital fractures should involved a careful eye examination, as the risk of concomitant traumatic optic neuropathy, potentially leading to permanent blindness has a 5% incidence4. Indications for operative management of orbital fractures include:

  • Traumatic optic neuropathy
    • Stabilization of TON with aggressive steroid therapy is indicated prior to surgical management
  • Extraocular muscle entrapment

Case contributed by A/Prof. Pramit Phal.