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General Overview of the Facial Trauma Evaluation
The initial evaluation of maxillofacial trauma in athletes should first focus on the management of life-threatening injuries that require emergent care. Airway, breathing, and circulation are the 3 areas to be addressed first and foremost, as set forth by Advanced Trauma Life Support (ATLS) guidelines. Following the stabilization of the patient, a thorough physical examination and systematic review of any relevant imaging studies are imperative to ensure that injuries are not missed. Ultimately, management by the facial plastic surgeon should balance the goals of facial trauma restoration with the overall needs of the pati...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: James Eng, Sunthosh Sivam Source Type: research

Nasal Fractures
This article outlines current methods in the evaluation and management of nasal fractures including clinical workup, imaging, and treatment. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Kelly C. Landeen, Kyle Kimura, Scott J. Stephan Source Type: research

Approach to Orbital Fractures After Athletic Injuries
The bony orbit is commonly involved in athletic injuries. Evaluation should include a comprehensive history and ocular examination. Computed tomography imaging is the gold standard for diagnostic testing. Urgent surgical intervention for orbital floor fractures should occur after “white eye” trapdoor fractures or if oculocardiac response occurs. Most orbital fractures do not require urgent intervention and repair can be completed within 2 weeks of injury. There are many approaches to repair orbital fractures, and consideration of techniques depends on the unique fractur e pattern. Intraoperative computed tomography ha...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: John Flynn Source Type: research

Zygomaticomaxillary Fractures
Fractures of the zygomaticomaxillary complex and zygomatic arch are common athletic injuries. Fracture displacement can lead to midfacial retrusion and widening, causing noticeable deformity. Associated signs and symptoms include hypoesthesia of the infraorbital nerve distribution, trismus, and subjective malocclusion. Operative treatment is indicated in cases of significant displacement or functional disturbance. The approach and details of osteosynthesis are catered to the specific characteristics of the fracture. Technology, such as virtual surgical planning, intraoperative navigation, and intraoperative imaging, has th...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Christine M. Jones, Cecelia E. Schmalbach Source Type: research

Midface Including Le Fort Level Injuries
Le Fort fractures occur at uniform weak areas in the midface often due to blunt impact to the face. Sporting injuries are a common cause of facial trauma; however, use of protective equipment has reduced the number of sports-related injuries. All patients with traumatic injuries should be evaluated using Advanced Trauma Life Support protocol. Le Fort fractures can contribute to airway obstruction, and urgent intubation may be indicated. Surgery is indicated for most displaced Le Fort fractures to restore function and facial harmony. To facilitate reduction, the original occlusive relationship should be restored by placing ...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Katherine A. Larrabee, Andrew S. Kao, Benjamin T. Barbetta, Lamont R. Jones Source Type: research

Frontal Sinus Fractures
Although frontal sinus fractures are relatively uncommon, the potential for long-term morbidity is significant. Management strategies remain controversial due to a lack of strong clinical evidence. Despite a paucity of strong literature, a logical treatment algorithm is presented based on the structural integrity of three anatomic parameters: anterior table, frontal sinus outflow tract, and the posterior table/dura. The literature supports a paradigm shift from open surgical management to a more conservative treatment algorithm emphasizing observation and minimally invasive endoscopic techniques. Long-term follow-up for co...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Steven G. Hoshal, Raj D. Dedhia, E. Bradley Strong Source Type: research

Mandibular Condylar Fractures
Mandibular condyle fractures can result in short-term and long-term morbidity. As a weak area of the mandible, the condyle is vulnerable to injury by a direct impact or an indirect force. Current treatment recommendations aim to better match the severity of the fracture with the choice of closed or open approach. Long-term follow-up of patients provides the best opportunity to monitor the degree of functional restoration after treatment. There is a growing consensus regarding the use of standardized fracture classification methods and outcomes measures that will allow better assessment of treatment results and strengthen t...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Sean Mooney, Rahul D. Gulati, Steve Yusupov, Sydney C. Butts Source Type: research

Mandibular Body Fractures
Fractures of the mandibular body most commonly occur after interpersonal violence or motorized vehicle accident but can occur in athletes. Mandibular body fractures are often associated with additional mandibular fractures. The treatment goal is to achieve preinjury occlusion and facial appearance, and this can be done via a closed reduction and maxillomandibular fixation or open reduction and fixation with or without maxillomandibular fixation. The authors present 3 cases in this article. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Sarah Mazher Kidwai, G. Nina Lu Source Type: research

Mandibular Angle Fractures
Angle fractures are the most common among the mandibular fractures. History and physical examination are crucial in guiding time course and specifics of management. Computed tomography (CT) has become the gold standard for diagnosis of mandible fractures, offering advantages for both surgical planning and assessing dental involvement. Currently the use of a single monocortical plate with the Champy technique for osteosynthesis is used preferentially for noncomminuted fractures of the mandibular angle. Other load-sharing options for plating include strut plates, malleable plates, and geometric or 3D plates. Load-bearing opt...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Gaelen Stanford-Moore, Andrew H. Murr Source Type: research

Dental Trauma and Alveolar Fractures
A dentoalveolar fracture requires thorough clinical and radiographic examination for an accurate diagnosis to guide appropriate treatment. Dentoalveolar fractures can be classified into the following 4 groups: (1) crown/root fractures, (2) luxation/displacement of teeth, (3) avulsion, and (4) alveolar fractures. Treatment can be divided into nonrigid fixation (splinting with wires and composite) and/or rigid fixation (Erich arch bars, Risdon cable wires) depending on the extent of dentoalveolar fractures. Special considerations must be made for primary teeth and mixed dentition to avoid injuring tooth buds and arising perm...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Jungsuk Cho, Alex Sachs, Larry L. Cunningham Source Type: research

Soft Tissue Injuries Including Auricular Hematoma Management
This article can serve as a basis for surgical pearls and considerations when evaluating and repairing facial soft tissue trauma. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Zachary A. Zimmerman, Douglas M. Sidle Source Type: research

Concussion in Head Trauma
Concussion in the setting of facial trauma is an entity that can be overlooked. Having a high index of suspicion is critical in initial management and prompt treatment. Clinical signs can be common manifestations of a concussion. Serial examinations are important as these clinical manifestations can occur later in the hospitalization. Cognitive assessment tools can also give a baseline of a patient and can be used to assess recovery from a concussion. Assessment of the vestibular and oculomotor system can play a critical role in treatment. Prompt recognition and immediate treatment can help shorten the symptomatology and c...
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: Vincent H. Key, Joseph B. Noland Source Type: research

Managing Craniomaxillofacial Injuries in Athletes
Competitive athletics remain immensely popular in our society among both youth and adults. Head and facial injuries are common during athletic activities, and the expertise of the facial trauma surgeon is frequently sought to treat these injuries. Facial injuries may account for up to 29% of athletic injuries, and 11% to 42% of all facial fractures are acquired during athletic activities. Soft tissue injuries and nasal bone fractures are most common. However, other injuries, such as zygomaticomaxillary, orbital, mandible, midface, and frontal sinus fractures, frequently occur. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: J. David Kriet, Clinton D. Humphrey Tags: Preface Source Type: research

Modern Approaches to Facial and Athletic Injuries
Facial trauma and injuries are frequent occurrences related to all types of athletic and sports activities. Both adults and children sustain facial injuries through athletic activities relatively frequently and often require treatment by facial plastic and reconstructive surgeons as well as general otolaryngologists, oral and maxillofacial surgeons, and plastic surgeons. When significant facial injuries are sustained by our patients, they often require evaluation and possible treatment for other injuries, such as concussion, ocular injuries, and dental areas of concern. (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: J. Regan Thomas Tags: Foreword Source Type: research

Modern Approaches to Facial and Athletic Injuries
FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA (Source: Facial Plastic Surgery Clinics of North America)
Source: Facial Plastic Surgery Clinics of North America - November 20, 2021 Category: Cosmetic Surgery Authors: J. David Kriet, Clinton D. Humphrey Source Type: research