• Face is very vulnerable
  
• Unprotected
  
• Rapid deceleration
  
• Motor vehicle crash
  
• Falls
  
• Usually follow Le Forte’s pattern of fractures
  
• Penetrating
  
• GSW
  
• Avulsions

General Assessment

• Frequent neuro checks

• TBI often accompany facial fractures

• Assess for facial nerve involvement

• Frequent vascular checks

• Is facial circulation interrupted due to initial injury or from secondary edema?

• Soft tissue damage

Le Forte Fractures

Le Forte I

• A transverse disarticulation of the maxillary dentoalveolar process from the remaining basal bone of the maxilla and midface

• Assess for epitaxis, broken or missing teeth, upper lip laceration
  

Le Forte II

• A pyramidal fracture involving the entire maxilla and nasal complex

• Assess for movement of the nose, upper dental arch

• You will see periorbital edema and ecchymosis, rhinorrhea, widening of the eyes

Le Forte III

• A complete craniofacial-midface disassociation (free floating face)

• Assess for orbital damage and/or occular trauma

• Assess for rhinorrhea, significant bleeding and edema

• Airway!!

• Gently suction inside of mouth and around nose

• No NG

• No nasal intubation

• All Le Forte fractures require surgical repair

• Pre-op prep

Post-op Management

• Airway

• Jaws will be wired – must have wire cutters at the bedside at all times

• NG/Dobhoff will be surgically placed

• Do not manipulate and make sure they remain patent

• Fluids & electrolytes

• Pain management and/or sedation

• Psych consults

Category: Orthopedics Notes