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Multiple open fractures of facial bones — Clinical Guidelines

Overview

Multiple open fractures of facial bones involve complex injuries requiring precise surgical intervention and multidisciplinary care to address both bone and soft tissue damage effectively. 1 7 12

Diagnosis

Clinical Assessment: Comprehensive evaluation of facial symmetry, mobility, and function. 10

Imaging: Preoperative CT scans essential for detailed fracture visualization. 1 9

Visual Acuity Testing: Critical in patients with orbital fractures to identify potential eye injuries. 6

Radiographic Reporting: Use of standardized systems for consistent interpretation of complex fractures. 9

Management

Surgical Techniques:

- Intraoperative Ultrasound: Utilize solid gel pad for improved visualization of facial fractures. 1 - Open Reduction: Consider for severe deviations or associated septal fractures, using approaches like subciliary incisions. 7 - Rigid Internal Fixation: Employ miniplates for rigid fixation, particularly in mandibular fractures. 13

Antibiotics: Prophylactic antibiotics recommended perioperatively; specific drug classes and dosing vary by specialty. 5

Documentation: Rigorous documentation of visual acuity and fracture specifics crucial for comprehensive care. 6

Special Populations

Pediatrics: Specific considerations for growth plate preservation and less invasive techniques may be necessary. (Not explicitly covered in abstracts)

Elderly: Increased risk of comorbidities; multidisciplinary care essential to manage associated health issues. 14

Comorbidities: Patients with pre-existing conditions may require tailored surgical and post-operative management plans. 14

Key Recommendations

Utilize intraoperative ultrasound with coupling mediums for precise reduction of facial fractures. (Evidence: Moderate 1)

Implement standardized radiographic reporting systems to ensure uniform interpretation of facial fractures. (Evidence: Moderate 9)

Employ multidisciplinary teams for complex facial fractures to optimize treatment outcomes. (Evidence: Expert opinion 14)

Provide prophylactic antibiotics perioperatively for facial fractures, adhering to specialty guidelines. (Evidence: Moderate 5)

Rigorously document visual acuity and fracture specifics to prevent complications related to overlooked injuries. (Evidence: Moderate 6)

References

1 Kim YG, Ryu JH, Lee KC. A Method for Precise Reduction of Facial Bone Fractures Using Intraoperative Ultrasound With a Solid Gel Pad as a Coupling Medium. The Journal of craniofacial surgery 2024. link 2 Ghosh R, Gopalkrishnan K. Facial Fractures. The Journal of craniofacial surgery 2018. link 3 Yang CS, Chen SC, Yang YC, Huang LC, Guo HR, Yang HY. Epidemiology and patterns of facial fractures due to road traffic accidents in Taiwan: A 15-year retrospective study. Traffic injury prevention 2017. link 4 Christophel JJ, Park SS, Nogan SJ, Essig GF. A Facial Trauma Simulation Course for Evaluation and Treatment of Facial Fractures. JAMA facial plastic surgery 2017. link 5 Brooke SM, Goyal N, Michelotti BF, Guedez HM, Fedok FG, Mackay DR et al.. A Multidisciplinary Evaluation of Prescribing Practices for Prophylactic Antibiotics in Operative and Nonoperative Facial Fractures. The Journal of craniofacial surgery 2015. link 6 Tahim AS, Bryant C, Greaney L, Rashid A, Fan K. Improving documentation of visual acuity in patients suffering facial fractures. Emergency medicine journal : EMJ 2013. link 7 Choi MS, Kim W, Youn S, Lee JH. Concomitant open reduction of a nasal bone fracture combined with a zygomatic fracture through a subciliary incision. The Journal of craniofacial surgery 2012. link 8 Lee LN, Bhattacharyya N. Contemporary trends in procedural volume for adult facial trauma, 1996-2006. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2012. link 9 Follmar KE, Baccarani A, Das RR, Erdmann D, Marcus JR, Mukundan S. A clinically applicable reporting system for the diagnosis of facial fractures. International journal of oral and maxillofacial surgery 2007. link 10 Carr MM, Freiberg A, Martin RD. Facial fractures. Canadian family physician Medecin de famille canadien 1994. link 11 Zachariades N, Papademetriou I, Rallis G. Complications associated with rigid internal fixation of facial bone fractures. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 1993. link80174-0) 12 Frodel JL, Marentette LJ. The coronal approach. Anatomic and technical considerations and morbidity. Archives of otolaryngology--head & neck surgery 1993. link 13 Ikemura K, Hidaka H, Etoh T, Kabata K. Osteosynthesis in facial bone fractures using miniplates: clinical and experimental studies. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 1988. link90293-5) 14 Chuong R, Mulliken JB, Kaban LB, Strome M. Fragmented care of facial fractures. The Journal of trauma 1987. link 15 Verheyden CN. An inexpensive wire passer. Plastic and reconstructive surgery 1986. link

Multiple open fractures of facial bones