- INTRODUCTION -
The maxillofacial trauma corresponds to all injuries of a traumatic origin that affects the facial components, including bones and soft tissues and the alveolo-dental structures.
Road traffic accident is still the leading cause of facial injuries (40-50%).
The distribution and type of fracture depend on the cause, mechanism, force, and age group. Zygomatic fractures as the most common subtype among midfacial fractures in both children and adults.
These fractures may be isolated or combined with other fractures and injuries including those in the head, spine, chest, abdomen, pelvis, and extremities.
Many of the facial fractures are seen in the context of high-energy trauma. Although the face is not a vital structure it´s crucial identify injuries or topographies that require urgent management (airway compromise, ocular injury, and massive bleeding).
In the emergency setting, clinical data collection may be limited by incomplete history, compromised physical examination, and impaired physician-patient communication. As a result, CT is often relied on to increase diagnostic certainty and to guide management.
Knowing the mechanism of injury is important in anticipating associated injuries and predicting facial fracture pattern ant its functional and aesthetic complications.
- IMAGING -
The gold standard for diagnosing bony trauma of the facial skeleton is computed tomography (CT).
In 2011, the “Wisconsin criteria” were established and validated as a method to predict which patients truly have a facial fracture and warrant further imaging.
Multiplanar computer reconstructions increase the effectiveness of visualisation of fractures, and 3D and MIP reconstructions are good complementary techniques.
When reporting a CT in this context it is essential the knowledge of the complex anatomy of facial bones.
The analysis and classification of facial bone fractures is possible with a model that was first partially introduced by Le Fort. It bases on the fact that the skeleton of the face is not just a collection of single bones but constitutes a system of horizontal and vertical reinforcement (buttresses), supporting one another mutually and determining how an impact force is distributed over the face. The concept of facial buttresses helps identify key areas of fracture, necessitating surgical fixation for restoration. Fixation is typically performed by using rigid titanium plates and screws anchored in the buttress.
Classical Le Fort classification has become less relevant in clinical practice. Instead, new approaches based on facial subunits and functional recovery are progressively being adopted by physicians.
The radiological report should avoid lists of individual fracture sites and must communicate their findings to surgeons effectively using a structured radiological report.