Maxillofacial trauma: principles of management, priorities and basic techniques

Abstract

The management of maxillofacial trauma involves organs and regions managed by various well-established health care disciplines and is therefore multidisciplinary. The organization of this multidisciplinary care includes: •Facility and personnel - the facility requires all the relevant diagnostic material and the personnel must have a special interest in maxillofacial trauma and form a dedicated team. •Principles of management of facial fractures - these involve setting priorities, understanding the indications for operative intervention and developing techniques, of which one of the most significant is the wider exposure of the maxillofacial skeleton. This, together with interosseous fixation with mini- and microplates and the use of primary bone grafting, has brought about the most significant advances in this area of patient management. Three case studies are presented, the first of which illustrates the management of a fractured zygoma requiring open reduction and internal fixation, using modern radiology to make the diagnosis and to check the correction. Case study two is an orbito-cranial fracture with major cranio-cerebral injury, highlighting the problems associated with a breech of the anterior cranial base and a cerebrospinal fluid rhinorrhoea. The third case illustrates a complex fracture involving the orbit and nasoethmoid complex, maxilla and mandible and illustrates the practical implication of the principles outlined in the paper.