TREATMENT Of FACIAL FRACTURES
Whenever facial structures are injured, treatment must be directed toward maximal rehabilitation of the. patient . For facial fractures, treatment goals include rapid bone, healing; a return of normal ocular. masticatory; and nasal
function; restoration of speech; and an acceptable facial . and dental esthetic result. During the treatment and healing phases, it is also importantto Illinimize the adverse effect on’ the patient’s nutritional status and achieve
treatrrient goals with the least amount of discomfort and inconvenience possible.
The timing of treatment of facial fractures depends on many factors. In general, it is always better to treat an injury as soon as possible. Evidence shows that the longer open or compound wounds are left untreated, the greater is the incidence of Infection. In additjon, a delay of several
davs or weeks makes an ideal anatomic reduction of the – fracture difficult if not impossible. Additionally, edema progressively worsens over 2 to 3 days after an injury and frequently makes treatment of a fracture’ marl’ difficult.
Although treatments of maxillary and mandibular’ fractures frequently have many aspects in common, these types of fractures arc addressed separately in this chapter: Traditionally the plan for treatment of most facial fractures was to begin with reduction of mandibular fractures
and worksuperiorly through the midface. The rationale was that the mandible could be most easily stabilized, and the occlusion and remainder of the facial skeleton could be set to the reduced mandible. However, with the advent of and improvement in rigid fixation techniques: faci~l fracture treatment -may begin rn the area where fractures can be most easily stabilized anti progrevse- to the most’ unstable fracture areas .
In approaching facial fractures, the surgeon attempts to rebuild the face based on the concept that certain bony structures within the face provide the primary support in the vertical and anteroposterior directions. Three buttresses exist bilaterally that form the primary vertical sup- .ports of the face: (1) the nasomaxillary, (2) the zygornatlc, ana (3) the pterygornaxillary buttresses (Fig. 24-17).6 The structures that support the facial projection in an anterior-posterior direction include the frontal bar, zygomatic arch and zygoma complex, maxillary alveolus and palate, and the basal segment of the mandible’? Regardj less of the type of facial fracture or the surgical approach used, the initial procedure should be to place the teeth in the proper occlusion and then appropriately reduce the bony fractures. Bony repair should also precede soft tissue repair.