0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

■ Pushing on the zygoma from inside the mouth allows you to examine the
bone without pushing on soft tissue directly over the bone, which may be
tender in the absence of a fracture.

DIAGNOSTICS

■ Facial films: Waters and submental vertex view (outdated)
■ Facial CT (1–3 mm coronal and axial cuts)

TREATMENT

■ Sinus precautions
■ Antibiotics (because of sinus involvement)
■ OMFS/ENT consult for fractures with neurologic abnormalities, prob-
lems with mastication, or cosmetics

MIDFACE FRACTURES

Le Fort Fractures

See Figure 14.14.

LEFORTI

■ Involves the maxilla at the level of the nasal fossa
■ Upper dental arch is mobile.

FIGURE 14.13. CT reconstruction of a right tripod fracture.

(Courtesy of Patrick W. Lappert, MD as published in Knoop KJ, Stack LB, Storrow AB. Atlas of
Emergency Medicine,2nd ed. New York: McGraw-Hill, 2002:11.)