Orbitozygomatic Fractures Research Articles

Evaluation of Shape and Volume Restoration of Orbit after Reduction of Orbitozygomatic Fractures

Abstract Background The appearance of the Orbitozygomatic complex (OZC) fracture terminology is contributed to the fact that a fracture in the lateral side of the midface is not strict to anatomical boundaries, however, it involves the zygoma, maxilla and orbital structures. Orbitozygomatic complex fractures are one of the most commonly encountered injuries of the craniofacial skeleton. The solid zygomatic bone acts as a part of the vertical and horizontal facial buttress, along with the malar eminence, which plays a key role in the determination of facial morphology. It forms a significant portion of the floor and lateral wall of the orbit thus it acts as one of the most common contributors to the orbital integrity, restoration of orbital volume is essential to prevent enophthalmos. Objective Evaluate restoration of orbital shape, volume and globe position in the anterior-posterior plane after reduction of zygomatico-orbital fractures. Methods This Prospective observational study was done from March 2023 to August 2023 at plastic, burn and maxillofacial department in El Demerdash Hospital, Ain Shams University. Eighteen (18) adult patients, complaining of post traumatic orbito-zygomatic fractures requiring operative intervention, were included in this study. Evaluations of orbital shape and differences between orbital volume measurements (damaged orbits compared to intact orbits before and after surgery), orbital volume calculated from area marked by delineating bony landmarks of the orbit interconnected by freehand cursor manually on a series of CT slices in the axial plane, the CT images were exported to the CMF orbital analysis software (adw4.7), where the volume was calculated automatically, Depth: measured from orbital rim to the orbital apex, from outer optic foramen to the middle point of a line passing through lateral and medial orbital rims; width: Maximal horizontal distance from lateral to medial rim and height: measured from superior to inferior margin at their maximum distance perpendicular to orbital width. Results The mean volume of the affected orbit throughout our study showed significant decrease from 24.81 ± 2.04 cm3 before the operation to 23.38 ± 2.22 cm3 after the surgical intervention (P < 0.001), indicating a highly significant difference, where volume has significantly increased on fractured side preoperative in comparison to the sound side (P = 0.016) indicating significant effect of trauma on increasing orbital volume from normal, while no statistical difference was noted (P = 0.75) between orbital volume of fractured side postoperatively 23.38 ± 2.22 cm3 and the sound side 23.24 ± 1.64 cm3, indicating proper reduction and restoration of orbital volume to near normal postoperatively, increased depth (45.46 ± 3.26), width (38 ± 2.94) and height (35.7 ± 2.98) of fractured side preoperatively; this increase was statistically significant, While Depth and width showed more increase than height; values were more statistically significant and return to near normal postoperatively (42.96 ± 2.68), (36 ± 2.88) and (34.23 ± 3.45) respectively; this decrease was still significant statistically except for height where it was non-significant, indicating better restoration of height than depth and width attributed to its lesser increase from the first place, as values of sound side weree (41.64 ± 2.25), (34.56 ± 3.25) and (34.51± 3.52) respectively. Conclusion Our study suggests that the surgical reduction of orbitozygomatic fractures has a significant role in restoration of the orbital shape, volume, and globe positioning in the anterior-posterior plane. And that enophthalmos occurrence is greatly influenced by increase of the bony orbital volume, also it’s affected by other factors for further research. Orbital dimensions were affected by trauma and restored to near normal after reduction but showed no major shape changes of the conical orbit.

Major clinical and surgical approaches to treating orbitozygomatic and zygomatic maxillary complex fractures: a systematic review

Introduction: In the scenario of orbitozygomatic fractures, facial and head injuries account for half of deaths due to trauma, and thousands are left with long-term or permanent injuries. Fractures of the zygomatic-maxillary complex (ZMC) and zygomatic arch are common athletic injuries. Operative treatment is indicated in cases of significant displacement or functional disturbance. Technology such as virtual surgical planning, intraoperative navigation, and intraoperative imaging has the potential to improve the accuracy of treatment of challenging fractures. Objective: It was to develop a systematic review of the main clinical and surgical approaches to the treatment of orbitozygomatic and zygomatic maxillary complex fractures. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 102 articles were found, 26 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.9%>50%. A single-piece fracture of the fronto-orbito-zygomatic-maxillary bone connected to a temporoparietal bone may require additional osteotomy to achieve successful results in an acute setting. Orbital volume analysis offers a valid modality for objectively evaluating the efficiency of the management of orbitozygomatic complex fractures. The success rate of the fixation procedure at 1 point of the zygomaticomaxillary complex is high, with minimal complications. Intraoperative CT/three-dimensional imaging should be used in the treatment of ZMC fractures requiring orbital floor reconstruction, where adjacent fractures require fixation and/or when ≥ 2 axes are displaced ≥ 5 mm.

Measuring orbital Volume Using Open Source Software and its Application in Orbitozygomatic Fractures.

Technical note. Changes in orbital volume can lead to esthetic and functional complications of the orbit. In this article, the procedure to calculate the orbital volume using the open source software Aliza 3D DICOM is described. This article describes the steps to use this novel software. To validate the software, the normal orbital volume was calculated bilaterally on CT scans with normal orbital anatomy. The volumes of unilateral orbitozygomatic fracture cases were compared. This open source software has easy access. The normal orbital volume calculated using this software was 24.4 cc ± 0.72. In the unilateral orbitozygomatic fracture cases, an increased orbital volume was calculated. This easy access, inexpensive, and convenient computer aided software can be used to calculate orbital volume facilitating treatment plan for correction of the orbit volume.

Correction of Post-Traumatic Enophthalmos by Orbital Floor Reconstruction with Titanium Mesh

Aim: To see the efficacy of titanium mesh in orbital floor reconstruction to correct the post-traumatic enophthalmos in orbito-zygomatic complex fractures. Methods: This retrospective study was carried out in the department of Oral and Maxillofacial Surgery, University College of Medicine & Dentistry, University of Lahore, Pakistan from January 2017 to January 2020. All patients who had enophthalmos after orbito-zygomatic fractures and were treated for orbital floor reconstruction with titanium mesh were included in the study. Computer tomography (CT scan) was done to diagnose and measure the orbital floor defect. Pre-operative and post-operative hertalex ophthalmometry was done to measure and compare the enophthalmos. Results: Among the 30 patients, 23 were male and 7 were female. The mean age of the patients was 30±5.80 years. Fourteen patients had right and 16 patients had left side orbitozygomatic complex fracture. The mean orbital floor defect size was 1.72±0.78 cm preoperatively measured by CT scan. There was a correction of enophthalmos in 23 patients out of 30(76.66%). Conclusion: Titanium mesh is a commonly used and easily available material for the correction of orbital floor defects. It is efficacious in terms of the correction of post-traumatic enophthalmos resulting from orbito-zygomatic complex fracture. Keywords: Enophthalmos, titanium mesh, orbitozygomatic fractures

Modified Suspension Suturing in Extended Exposure Orbitozygomatic Fractures: A Technical Note and Brief Literature Review

Modified Suspension Suturing in Extended Exposure Orbitozygomatic Fractures: A Technical Note and Brief Literature Review

South Australian facial trauma: a population analysis of social economic deprivation and facial fractures


 
 
 Background: Trauma remains a leading cause of morbidity and mortality in Australia. The objective of this South Australian study was to analyse epidemiological trends in facial fractures and assess the relationship between socioeconomic disadvantage and clinical outcomes. Part one of this paper includes methods and results; part two includes discussion and conclusion. The two papers should be read together.
 Method: A retrospective analysis of the relationship was conducted between socioeconomic disadvantage and facial fractures. All paediatric and adult patients with facial fractures who attended the Royal Adelaide Hospital and the Women’s and Children’s Hospital Adelaide between January
 2012 and January 2017 either as in- or outpatients. The medical records, progress notes, imaging and operative notes from plastics, craniofacial and oral maxillofacial surgery teams were retrospectively collated into a registry and reviewed. Ethics approval was granted from the RAH Human Research and Ethics Committee [HREC/17/RAH/402].
 Results: A total of 2559 patients, 1976 males (77.2%) and 583 females (22.8%), sustained a facial fracture. The most disadvantaged group had the highest proportion of facial fractures (36.9%), with the highest incidence in the 25–34 age group (22.4%). Assaults were the most common injury with decreasing odds as socioeconomic advantage increased (p<0.05). Orbitozygomatic fractures were the most common type of facial fracture (27.7%). Indigenous patients were more likely (OR=2.8) to have surgery compared to non–indigenous patients (p<0.05). There were no significant differences in length of stay between socioeconomic groups (F(4,964.387)=2.091, p = 0.080).
 Conclusion: Socioeconomic status strongly influences the mechanisms on injury, types of fracture and likelihood of surgery with the most disadvantaged having higher rates compared to the least disadvantaged.
 
 

South Australian facial trauma: a population analysis of social economic deprivation and facial fractures

Background: Trauma remains a leading cause of morbidity and mortality in Australia. The objective of this South Australian study was to analyse epidemiological trends in facial fractures and assess the relationship between socioeconomic disadvantage and clinical outcomes. Part one of this paper includes methods and results; part two includes discussion and conclusion. The two papers should be read together. Method: A retrospective analysis of the relationship was conducted between socioeconomic disadvantage and facial fractures. All paediatric and adult patients with facial fractures who attended the Royal Adelaide Hospital and the Women’s and Children’s Hospital Adelaide between January 2012 and January 2017 either as in- or outpatients. The medical records, progress notes, imaging and operative notes from plastics, craniofacial and oral maxillofacial surgery teams were retrospectively collated into a registry and reviewed. Ethics approval was granted from the RAH Human Research and Ethics Committee [HREC/17/RAH/402]. Results: A total of 2559 patients, 1976 males (77.2%) and 583 females (22.8%), sustained a facial fracture. The most disadvantaged group had the highest proportion of facial fractures (36.9%), with the highest incidence in the 25–34 age group (22.4%). Assaults were the most common injury with decreasing odds as socioeconomic advantage increased (p<0.05). Orbitozygomatic fractures were the most common type of facial fracture (27.7%). Indigenous patients were more likely (OR=2.8) to have surgery compared to non–indigenous patients (p<0.05). There were no significant differences in length of stay between socioeconomic groups (F(4,964.387)=2.091, p = 0.080). Conclusion: Socioeconomic status strongly influences the mechanisms on injury, types of fracture and likelihood of surgery with the most disadvantaged having higher rates compared to the least disadvantaged.

Frequency of Satisfactory Outcome after Surgical Management in Isolated Orbitozygomatic Fractures

Objective: To determine the frequency of satisfactory outcome after Surgical Management in Isolated Orbitozygomatic fractures.
 Study Design: Case series Descriptive study.
 Place and Duration: Oral Maxillofacial Surgery Department of Dentistry, Liaquat University of Medical Health Science, Jamshoro ,from 11thAugust 2020 to10thMarch 2021.
 Methodology: Total 87 patients of Isolated Orbitozygomatic fractures with Enophthalmos and or Diplopia were included. All patients were operated, open reduction and internal fixation of zygoma at 3 points. Postoperatively Diplopia was ruled out by a range of eye movements and Enophthalmos was measured by Hertel Exophthalmometer. Final assessment was done after six weeks postoperatively. Descriptive statistics were calculated. Stratification was done and poststratification chi square test or t-test was applied. P-value ≤0.05 was considered as significant.
 Results: There was 85.1% male and 14.9% female. Mean age was 33.45±7.93 years. 73.6% were classified as ASA-I and 26.4% were classified as ASA-II. At first, third and sixth week, 4.6% patients were found with positive upward gaze, 2.3% with positive down gaze, 0% with positive horizontal gaze and 2.3% with positive secondary peripheral gaze while 85.1% with < 3 mm Enophthalmoson Hertel Exopthelmommeter and 13(14.9%) with >3 mm Enophthalmoson Hertel Exopthelmommeter. The satisfactory outcome was 88.5%.
 Conclusion: Our study results showed 88.5% satisfactory outcome. The long-term prognosis after repair of zygomaticomaxillary complex fractures is very good.

Pediatric Facial Fractures in South Australia: Epidemiology, Clinical Characteristics, and Outcomes.

Facial fractures of children are relatively infrequent compared to adults. There are variations in facial fractures depending on the socioeconomic, cultural, and educational factors of the country and time. Our aim is to describe epidemiological trends of facial fractures in the pediatric population, understand differences amongst the age groups, and the impact this has on clinical outcomes and management in South Australia. A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hosptial, Adelaide. All facial fractures of children, aged 16 years and below, that attended or were referred to the unit were included in this study. A total of 265 pediatric patients presented with a facial fracture with a male predominance. Some 49.1% occurred from a sports-related injury with bicycle motocross as the single most common type of sport. The mandible was the common fracture type with 21.9% of the total cohort having an associated injury. There were significant differences between boys and girls for age, age groups, mechanism of injury, and type of sport (P < 0.05). Boys were 2.3 times more likely to have a sport-related facial fracture than girls. Early adolescence were 5.2 times more likely to have an orbitozygomatic fracture than children of early childhood (P < 0.05). Age, associated injuries, and sport-related facial fractures were independently associated with increased length of stay (P < 0.001). There are differences amongst boys and girls and an understanding of these differences can aid the diagnosis and management in a growing child's face.

Facial fractures in the elderly: epidemiology, clinical characteristics, and management

With an ageing population, the elderly will increasingly represent a growing subgroup of trauma. A high-risk group with multiple comorbidities, decreased physiological reserves and frailty, this contributes to the complexity of management in facial trauma. Falls represent the most common presentation for facial-related injuries, but there are variations amongst gender that is important to aid diagnosis, management, and treatment plans. Our aim is to identify epidemiological trends of facial fractures in the elderly, understand differences amongst gender and elderly age groups, and the impact this has on clinical outcomes and management. A retrospective review was conducted from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. All facial fractures of the elderly, 65 years and above, that attended or were referred to the unit were included in this study. Three hundred fifty-five elderly patients presented with a facial fracture with falls (82.5%) as the most common mechanism of injury. The orbitozygomatic fracture was the most common type of facial fracture with 48.7% of the cohort sustaining an associated injury. There were differences between men and women for age, age groups, socioeconomic status, season, alcohol, mechanism of injury, and facial fractures (p<0.05). The 75–85 and 85+ age groups were 2.4 and 15.1 times more likely to have a fall-related facial fracture than the 65–75 age group, and less likely to have surgery (p<0.05). Associated injuries were independently associated with increased length of stay (p<0.001). Geriatric men and women have differences in facial fractures and aetiologies, but an overall non operative approach was favoured on a balanced approach of comorbidities, function, and quality of life. Elderly patients are complex with associated injuries and comorbidities, and they often require interdisciplinary care across fields of medicine and surgery to minimize their length of stay and yield good outcomes. Level of evidence: Level III, therapeutic; diagnostic; risk/prognostic study.

Animal-related facial fractures in South Australia.

Animal-related facial fractures can affect livelihoods impacting the hard and soft tissues of the face. Animal husbandry and recreational sports have close relationships with animals, which can lead to injuries equivalent to those of road traffic accidents and assaults. Our aim is to describe epidemiological trends of animal-related facial fractures in the paediatric and adult age group across South Australia. A retrospective review from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital in Adelaide. All animal-related injuries that attended or were referred to the unit were included in this study. There were 50 patients who presented with an animal-related facial fracture. There was an equal distribution of males to females with horses as the most common animal to cause injury from kicking. The orbit and orbitozygomatic fracture equally represented the most common type of facial fracture with 38% of all cases having an associated injury. The operative rate was 56% with four post-operative complications. There were differences between males and females for season, post-operative complications and length of stay (P < 0.05). Females, multiple fractures and associated injuries were independently associated with increased length of stay (P=0.001). Female adolescents and young women involved with horses were more likely to have facial fractures with associated injuries, post-operative complications and an extended length of stay compared to males. Educational awareness for trainees about interdisciplinary care and prevention strategies for patients are key to better understanding and managing facial trauma.

The coventry orbital fracture index: turning images into numbers

In cranio-maxillofacial trauma practice the anatomical description of orbito-zygomatic fracture patterns based on reformatted computerised tomography (CT) images is generally used, frequently with quantifying-descriptive terms such as hairline, minimally/moderately/severely displaced, rotated, comminuted, etc.

Update on the management of orbitozygomatic fractures

Orbitozygomatic fractures are an important aspect of facial trauma. Although the literature in maxillofacial surgery is rich on the question, this article resulting from the experience of a maxillofacial surgeon brings additional data in the knowledge of the subject. This is particularly the case with regard to the principles of examination, the pathways first, the principles of restraint and osteosynthesis, and the various surgery-related complications, as well as the precautions to be adopted to minimize them. The most important thing to remember is that the management approach is often variable, and the right choice is summed up in the clinical perception and level of expertise and comfort of the surgeon, while also considering the patient's point of view.

Applications of 3D orbital computer-assisted surgery (CAS).

The purpose of the present report is to describe the indications for use of 3D orbital computer-assisted surgery (CAS). We analyzed the clinical and radiological data of all patients with orbital deformities treated using intra-operative navigation and CAD/CAM techniques at the Hôpitaux Universitaires de Genève, Switzerland, between 2009 and 2016. We recorded age and gender, orbital deformity, technical and surgical procedure and postoperative complications. One hundred and three patients were included. Mean age was 39.5years (range, 5 to 84years) and 85 (87.5%) were men. Of the 103 patients, 96 had intra-operative navigation (34 for primary and 3 for secondary orbito-zygomatic fractures, 15 for Le Fort fractures, 16 for orbital floor fractures, 10 for combined orbital floor and medial wall fractures, 7 for orbital medial wall fractures, 3 for NOE (naso-orbito-ethmoidal) fractures, 2 for isolated comminuted zygomatic arch fractures, 1 for enophthalmos, 3 for TMJ ankylosis and 2 for fibrous dysplasia bone recontouring), 8 patients had CAD/CAM PEEK-PSI for correction of residual orbital bone contour following craniomaxillofacial trauma, and 1 patient had CAD/CAM surgical splints and cutting guides for correction of orbital hypertelorism. Two patient (1.9%) required revision surgery for readjustment of an orbital mesh. The 1-year follow-up examination showed stable cosmetic and dimensional results in all patients. This study demonstrated that the application of 3D orbital CAS with regards to intra-operative navigation and CAD/CAM techniques allowed for a successful outcome in the patients presented in this series.

ACESSO TRANSCONJUNTIVAL NA ABORDAGAGEM DE FRATURA DO ASSOALHO ORBITAL: RELATO DE CASO

Objective: Fractures in the face require approaches with predictable esthetic results, seeking access to minimize scars and to lower complication rates. Among the extraoral access to approach the infraorbital margin there are cutaneous accesses (subciliary, subtarsal and infraorbital) and Transconjunctival with some variations. The transconjuntivais access enable orbital floor display, infraorbital rim and medial orbital wall for placement of grafts, osteotomies and osteosynthesis, leaving imperceptible scars in the conjunctiva. The zygomatic complex is anatomically located in the midface and due to its anterior projection it is quite affected by trauma, and facial bone structure, after the nasal bones, more prone to fractures. Case Description: This paper discusses a clinical case on the transconjunctival access to orbitozygomatic fracture approach of a female patient JJC, 30, discussing their indications, techniques and complications. Conclusion: From the diagnosis, the recommended treatment was the transconjunctival access to approach orbitozygomatic fracture.

ACESSO TRANSCONJUNTIVAL NA ABORDAGAGEM DE FRATURA DO ASSOALHO ORBITAL: RELATO DE CASO

Objetivo: As fraturas na face necessitam de abordagens com resultados estéticos previsíveis, buscando acessos que minimizem cicatrizes e com baixos índices de complicações. Dentre os acessos extraorais para abordagem da margem infraorbital são descritos acessos cutâneos (subciliar, subtarsal e infraorbitário) e o transconjuntival com algumas variantes. Os acessos transconjuntivais possibilitam a exposição do assoalho da órbita, rebordo infraorbitário e parede medial da órbita para colocação de enxertos, osteotomias e ostessínteses, deixando cicatriz imperceptível na conjuntiva. O complexo zigomático está anatomicamente situado no terço médio da face e devido a sua projeção anteriorizada é bastante acometido por traumatismos, sendo a estrutura óssea facial, depois dos ossos próprios do nariz e da mandíbula, mais sujeita a fraturas. Descrição do caso: Este trabalho aborda caso clinico sobre o acesso transconjuntival para abordagem de fratura orbito-zigomatica de uma paciente gênero feminino JJC,30 anos, discutindo suas indicações, técnicas e complicações. Conclusão: A partir do diagnóstico, o tratamento proposto foi o acesso transconjuntival para abordagem da fratura orbito-zigomática.

Reconstruction of temporal and zygomatic posttraumatic defect with polyetheretherketone custom made — case report

Traumatic brain injury (TBI) that requires decompressive craniotomies procedures for encephalic protection usually leads to cranial defects compromising patient aesthetics because of asymmetries. Orbitozygomatic fractures are common to car accidents and it correction is made during acute approach of trauma, but in a TBI patient this surgical correction is made as a trauma sequel. A 26-year-old patient with TBI sequel and right Class V (Knight and North) zygomatic fracture secondary to metallic object ejected by a vehicle that led to severe TBI and right temporal and zygomatic fracture that required emergency craniotomy and intensive care unit care for two months. Patient was discharged without any kind of reconstruction or fracture reduction. Patient consulted one year after trauma because of osseous defect in temporal right area and orbitozygomatic asymmetry, so it was decided to perform fracture reduction and defect reconstruction with a PEEK (polyetheretherketone) custom made for the temporal area with titanium plates and screws for fixation and for zygomatic area, a special design was made to protect infraorbital nerve and improve implant insertion. Immediate satisfactory results and asymmetry correction was obtained.

Sliced Costochondral Chip Grafts in Posttraumatic Enophthalmos Correction.

Posttraumatic enophthalmos is a relatively common problem following orbitozygomatic fractures. However, inadequate long-term results are frequently observed due to the difficulty of performing intraoperative fine adjustments to soft-tissue volume and orbital size and gradual absorption of some grafted materials. Here, the authors describe an efficient method of enophthalmos correction using sliced costochondral bone and cartilage combination grafts. From 2005 to 2011, the authors corrected enophthalmos in 12 patients using sliced costochondral grafts. The mean follow-up period was 13 months. For costochondral graft harvest, an approximately 5-cm skin incision was made directly above the seventh costal cartilage, the perichondrium was peeled back, and a small piece of rib bone and costal cartilage was harvested from the anterior part of the seventh rib bone and cartilage and cut into 2-mm-thick slices. A subciliary and/or transcaruncular incision was made in the affected side eyelid to expose the operating field, subperiosteal dissection was performed in the orbit and orbital floor. The cartilage chips were gradually grafted onto the dissected areas from the posterior orbit. Aesthetically satisfactory results were obtained in all patients. No complications in the donor area were observed. Furthermore, no patients experienced a recurrence or deterioration of diplopia over the follow-up period. One patient experienced temporary high intraocular pressure, which spontaneously resolved with medication and eye drops. The costochondral graft is adequate for the reconstruction of the fracture, easy to obtain, easily adaptable to the orbital walls, and has minimal morbidity at the donor site.

A Unique Case of Gossypiboma following Treatment of the Orbitozygomatic Complex Fracture

Transmaxillary approach to the orbital floor has been used successfully to treat the blowout fracture by antral packing to support the orbital floor. However, antral packs are associated with a high incidence of infection and persistent oroantral fistula. A 30-year-old man with a history of the orbitozygomatic complex fracture 8 years ago presented with a persistent facial wound on the right side of the cheek. The patient underwent an exploratory surgery under general anesthesia, and the maxillary sinus was approached through the Caldwell-Luc operation and a long 2-m nasal tampon was found in the sinus. Foreign bodies including gossypibomas are rare, hard to diagnose, and mostly asymptomatic and in chronic cases do not reveal specific radiological and clinical signs for differential diagnosis. Therefore, in the evaluation of the soft-tissue lesions in patients with a history of a prior operation, it is wise to consider foreign bodies in the differential diagnosis.

Injuries to the Face and Jaw

The human face is vulnerable to injury most frequently as the target of interpersonal violence or when inadequately restrained within a motor vehicle collision. Injuries to both the soft tissues and skeleton of the face are common reasons of emergency department admissions and consultations. Isolated maxillofacial trauma is rarely life threatening or an immediate cause of death unless associated with airway compromise; however, approximately 20% of all patients with facial soft tissue, dentoalveolar, or facial fracture trauma have associated injury to additional body systems. In particular, motor vehicle crash victims, personal assault, occupational injuries, and motorcycle crash victims may have associated injuries to additional body systems. This review covers the assessment and management of maxillofacial fractures, initial evaluation, comprehensive survey, treatment of soft tissue injuries, and treatment of maxillofacial fractures. Figures show a patient with a combination of blunt and penetrating trauma to the central face; fractured mandible; fractured zygoma; infraorbital fracture; broken nose; soft tissue injuries involving the facial nerve distal to the vertical line, likely too small for primary repair; injuries to the parotid duct repaired by passing a catheter through the Stensen duct and through the area of laceration and then repairing the parotid duct over the catheter; mandibular fracture; Le Fort I, Le Fort II, and Le Fort III fractures; findings in patients with Le Fort III maxillary fractures immediately after injury, before obliterative edema develops; and preoperative and postoperative right-sided orbitozygomatic fracture. This review contains 12 highly rendered figures, and 29 references Key words: Jaw injuries; Face injuries; Maxillofacial injuries; Le Fort level; Facial fractures; Orbital fractures; Maxillary fractures;