The face includes an underlying bony skeletal support structure with a very complicated 3D structure.
The skeleton provides facial shape, which is important for both function and cosmesis.
The skeleton also provides support and protection for viscera, including the eyes and brain.
The paranasal sinuses are mucosally lined cavities within the facial skeleton. These may lighten the face/head, and they also serve as a protective “crumple zone” for the nearby viscera.
The upper and lower jaws contain teeth, which are important for chopping food for both swallowing and digestion.
The lower jaw is mobile and is suspended from the cranium by the two temporomandibular joints.
The bony skeleton is covered by soft tissues of various thicknesses, including periostium, muscles, fat, and skin.
Viscera of the facial area include the brain, the eyes, the oral structures, the major and minor salivary glands, as well as nerves, blood vessels, and lymphatics.
Facial injuries may affect any of the above-noted structures. Familiarity with normal anatomy is the key to being able to reestablish it after it has been disrupted by an injury.
Visceral injuries are managed to reestablish function.
Soft tissue repair is done to reestablish covering and to minimize the visibility of any scars. Acute repair may require the use of local or other flaps or grafts.
Facial nerve injuries should be identified early, and if there is a peripheral nerve injury, exploration and repair at the earliest opportunity should be considered
Similarly, injuries to main salivary ducts should be explored and repaired.
The focus is on the craniomaxillofacial (CMF) skeleton.
For purposes of this chapter, the CMF skeleton is divided into three areas:
Upper third: includes the forehead, including the frontal bones, supraorbital rims, and glabella.
Middle third: includes the zygomas, maxillae, nasal bones, and orbits, and it can include the vertical rami of the mandible.
Lower third: comprised of the mandible, generally anterior to the vertical rami.
The nasal septum is a midline structure in both the middle and lower thirds.