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Complex Facial Fracture
Blair A. Winegar, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Complex facial fracture (CFFx)
            • Synonyms

              • Facial smash injury, panfacial fracture
            • Definitions

              • No widely accepted definition of CFFx or panfacial fracture
              • Definitions include
                • Severely comminuted fractures involving multiple facial bones that do not follow pattern described for traditional transfacial (Le Fort) fracture
                • Fractures involving upper, middle, & lower face (nasoorbitalethmoidal, zygomaticomaxillary complex, central midface, & mandible)
                • Fracture patterns involving both midface & mandible

            IMAGING

            • General Features

              • Imaging Recommendations

                • CT Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                Selected References

                                1. Alasraj A et al: Does intraoperative computed tomography scanning in maxillofacial trauma surgery affect the revision rate? J Oral Maxillofac Surg. 79(2):412-9, 2021
                                2. Cuddy K et al: Management of zygomaticomaxillary complex fractures utilizing intraoperative 3-dimensional imaging: the ZYGOMAS protocol. J Oral Maxillofac Surg. 79(1):177-82, 2021
                                3. Causbie J et al: Complications following orbital floor repair: impact of intraoperative computed tomography scan and implant material. Facial Plast Surg Aesthet Med. ePub, 2020
                                4. Gabrick K et al: Radiographic predictors of FACE-Q outcomes following non-operative orbital floor fracture management. J Craniofac Surg. 31(4):e388-91, 2020
                                5. Pontell ME et al: Influence of radiographic soft tissue findings on clinical entrapment in patients with orbital fractures. J Craniofac Surg. ePub, 2020
                                6. Cornelius CP et al: The comprehensive AOCMF classification system: midface fractures - level 3 tutorial. Craniomaxillofac Trauma Reconstr. 7(Suppl 1):S068-91, 2014
                                7. Morrison CS et al: Use of intraoperative computed tomography in complex craniofacial trauma: an example of on-table change in management. Craniomaxillofac Trauma Reconstr. 7(4):298-301, 2014
                                8. Uzelac A et al: Orbital and facial fractures. Neuroimaging Clin N Am. 24(3):407-24, vii, 2014
                                9. Chung KJ et al: Treatment of complex facial fractures: clinical experience of different timing and order. J Craniofac Surg. 24(1):216-20, 2013
                                10. de Melo WM et al: Using the "bottom-up and outside-in" sequence for panfacial fracture management: does it provide a clinical significance? J Craniofac Surg. 24(5):e479-81, 2013
                                11. Mundinger GS et al: Blunt-mechanism facial fracture patterns associated with internal carotid artery injuries: recommendations for additional screening criteria based on analysis of 4,398 patients. J Oral Maxillofac Surg. 71(12):2092-100, 2013
                                12. Winegar BA et al: Spectrum of critical imaging findings in complex facial skeletal trauma. Radiographics. 33(1):3-19, 2013
                                13. Ahmad Z et al: Towards a classification system for complex craniofacial fractures. Br J Oral Maxillofac Surg. 50(6):490-4, 2012
                                14. Bell RB: Computer planning and intraoperative navigation in cranio-maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 22(1):135-56, 2010
                                15. Canter HI et al: Use of rigid external distraction device in treatment of complex maxillofacial fractures. J Craniofac Surg. 19(2):306-12, 2008
                                16. He D et al: Panfacial fractures: analysis of 33 cases treated late. J Oral Maxillofac Surg. 65(12):2459-65, 2007
                                17. Sargent LA: Nasoethmoid orbital fractures: diagnosis and treatment. Plast Reconstr Surg. 120(7 Suppl 2):16S-31S, 2007
                                18. Saigal K et al: Use of three-dimensional computerized tomography reconstruction in complex facial trauma. Facial Plast Surg. 21(3):214-20, 2005
                                19. Clauser L et al: Severe panfacial fracture with facial explosion: integrated and multistaged reconstructive procedures. J Craniofac Surg. 14(6):893-8, 2003
                                20. Buitrago-Téllez CH et al: A comprehensive classification of craniofacial fractures: postmortem and clinical studies with two- and three-dimensional computed tomography. Injury. 33(8):651-68, 2002
                                21. Girotto JA et al: Long-term physical impairment and functional outcomes after complex facial fractures. Plast Reconstr Surg. 108(2):312-27, 2001
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Pathology

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Complex facial fracture (CFFx)
                                          • Synonyms

                                            • Facial smash injury, panfacial fracture
                                          • Definitions

                                            • No widely accepted definition of CFFx or panfacial fracture
                                            • Definitions include
                                              • Severely comminuted fractures involving multiple facial bones that do not follow pattern described for traditional transfacial (Le Fort) fracture
                                              • Fractures involving upper, middle, & lower face (nasoorbitalethmoidal, zygomaticomaxillary complex, central midface, & mandible)
                                              • Fracture patterns involving both midface & mandible

                                          IMAGING

                                          • General Features

                                            • Imaging Recommendations

                                              • CT Findings

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Staging, Grading, & Classification

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              Selected References

                                                              1. Alasraj A et al: Does intraoperative computed tomography scanning in maxillofacial trauma surgery affect the revision rate? J Oral Maxillofac Surg. 79(2):412-9, 2021
                                                              2. Cuddy K et al: Management of zygomaticomaxillary complex fractures utilizing intraoperative 3-dimensional imaging: the ZYGOMAS protocol. J Oral Maxillofac Surg. 79(1):177-82, 2021
                                                              3. Causbie J et al: Complications following orbital floor repair: impact of intraoperative computed tomography scan and implant material. Facial Plast Surg Aesthet Med. ePub, 2020
                                                              4. Gabrick K et al: Radiographic predictors of FACE-Q outcomes following non-operative orbital floor fracture management. J Craniofac Surg. 31(4):e388-91, 2020
                                                              5. Pontell ME et al: Influence of radiographic soft tissue findings on clinical entrapment in patients with orbital fractures. J Craniofac Surg. ePub, 2020
                                                              6. Cornelius CP et al: The comprehensive AOCMF classification system: midface fractures - level 3 tutorial. Craniomaxillofac Trauma Reconstr. 7(Suppl 1):S068-91, 2014
                                                              7. Morrison CS et al: Use of intraoperative computed tomography in complex craniofacial trauma: an example of on-table change in management. Craniomaxillofac Trauma Reconstr. 7(4):298-301, 2014
                                                              8. Uzelac A et al: Orbital and facial fractures. Neuroimaging Clin N Am. 24(3):407-24, vii, 2014
                                                              9. Chung KJ et al: Treatment of complex facial fractures: clinical experience of different timing and order. J Craniofac Surg. 24(1):216-20, 2013
                                                              10. de Melo WM et al: Using the "bottom-up and outside-in" sequence for panfacial fracture management: does it provide a clinical significance? J Craniofac Surg. 24(5):e479-81, 2013
                                                              11. Mundinger GS et al: Blunt-mechanism facial fracture patterns associated with internal carotid artery injuries: recommendations for additional screening criteria based on analysis of 4,398 patients. J Oral Maxillofac Surg. 71(12):2092-100, 2013
                                                              12. Winegar BA et al: Spectrum of critical imaging findings in complex facial skeletal trauma. Radiographics. 33(1):3-19, 2013
                                                              13. Ahmad Z et al: Towards a classification system for complex craniofacial fractures. Br J Oral Maxillofac Surg. 50(6):490-4, 2012
                                                              14. Bell RB: Computer planning and intraoperative navigation in cranio-maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 22(1):135-56, 2010
                                                              15. Canter HI et al: Use of rigid external distraction device in treatment of complex maxillofacial fractures. J Craniofac Surg. 19(2):306-12, 2008
                                                              16. He D et al: Panfacial fractures: analysis of 33 cases treated late. J Oral Maxillofac Surg. 65(12):2459-65, 2007
                                                              17. Sargent LA: Nasoethmoid orbital fractures: diagnosis and treatment. Plast Reconstr Surg. 120(7 Suppl 2):16S-31S, 2007
                                                              18. Saigal K et al: Use of three-dimensional computerized tomography reconstruction in complex facial trauma. Facial Plast Surg. 21(3):214-20, 2005
                                                              19. Clauser L et al: Severe panfacial fracture with facial explosion: integrated and multistaged reconstructive procedures. J Craniofac Surg. 14(6):893-8, 2003
                                                              20. Buitrago-Téllez CH et al: A comprehensive classification of craniofacial fractures: postmortem and clinical studies with two- and three-dimensional computed tomography. Injury. 33(8):651-68, 2002
                                                              21. Girotto JA et al: Long-term physical impairment and functional outcomes after complex facial fractures. Plast Reconstr Surg. 108(2):312-27, 2001