Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Causes ++ Facial injuries can vary from the most minor laceration to the most severe disruption of the face, as seen in shotgun blasts. Often described as blunt or penetrating and by the amount of energy. Low impact (so-called “low energy”) injuries are often due to falls and fights. Moderate energy injuries are often due to low-velocity vehicular trauma, falls from moderate height, and interpersonal trauma that involves a blunt weapon. High-energy injuries are often due to high-speed vehicular trauma and recreational vehicles, industrial accidents, and falls from height. Penetrating injuries are often due to gunshots and can vary from small holes and limited damage to areas of destruction and major tissue loss. Management depends upon the nature of the injury. +++ Anatomy ++ 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. +++ Diagnosis ++ Must assess ABCs first Always consider cervical spine injury Always assess neurological status and obtain consultation as indicated Clinical Observation Obvious injuries Soft ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.