The Radiology of Facial Fractures


It has been argued that the recognition of facial fractures depends upon detailed knowledge of the normal radiographic anatomy of the facial bones. Critical structures have, therefore, been identified in all of the conventional radiographic projections as well as in conventional and computed tomographic sections.

Direct and indirect signs of fracture have been enumerated and multiple examples of facial fractures have been illustrated with clinical radiographs.

Facial injuries have been considered in three major groups: 1, local facial injuries including blowout fractures of the orbital floor, orbital rim fractures, nasal arch fractures and zygomatic arch fractures; 2, the tripod fracture and its variants; and 3, the complex fractures including LeFort I, II and III fractures, LeFort variations such as LeFort-tripod fracture combinations, and the most severe of facial fractures, the “smash” type of injury.

To facilitate the detection of facial fractures, systematic patterns for the sequential evaluation of critical structures have been proposed, and the value of supplementary radiographic projections particularly for the evaluation of tripod fractures has been noted.

With few exceptions, facial fractures involve the orbit and the need for particular care in the evaluation of the orbital rims (upper and lower), the orbital floor, fissures and apex, and the oblique orbital line has been emphasized.

Kenneth D. Dolan, Charles G. Jacoby and Wendy R. K. Smoker