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Albrecht T, Burkhardt V, Offergeld C. [Trauma of the midface : Symptoms, diagnostics and treatment]. HNO 2024:10.1007/s00106-024-01492-1. [PMID: 38913183 DOI: 10.1007/s00106-024-01492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024]
Abstract
Midface fractures present a clinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides a radiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires a multidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.
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Affiliation(s)
- Tobias Albrecht
- Klinik für Hals-,Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland, Elfriede-Aulhorn-Straße 5, 72076.
| | - Valentin Burkhardt
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Christian Offergeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
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Thomas AB, Pawar SS. Approaches to the Maxillofacial Skeleton: Application of Standard and Minimally Invasive Techniques. Otolaryngol Clin North Am 2023; 56:1079-1088. [PMID: 37353367 DOI: 10.1016/j.otc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Management of maxillofacial trauma is complex and challenging and requires a clear understanding of facial anatomy and function. There are multiple approaches that can be used to access each anatomical region, each with specific indications and complication profiles. Open, "invasive" approaches are being replaced or augmented with minimally invasive and endoscopic approaches when possible. Thorough knowledge of indications, surgical techniques, and potential complications allows surgeons to make appropriate decisions for access and repair of fractures. This article is a comprehensive review of standard and minimally invasive approaches, with description of techniques and pros and cons for their use.
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Affiliation(s)
- Abigail B Thomas
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Application of 3D Imaging-Assisted Precise Aesthetic Evaluation in Midfacial Depression Treatment. Aesthetic Plast Surg 2022; 46:2799-2806. [PMID: 35475937 DOI: 10.1007/s00266-022-02867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/13/2022] [Indexed: 01/01/2023]
Abstract
Most Chinese have unpleasant facial profile of midfacial depression, which could be caused by multiple reasons. In the past, LeFort osteotomy and orthodontic methods were applied for surgical treatment of midfacial concavity. As the development of plastic surgery filling techniques, nasal base filling or concurrent comprehensive rhinoplasty has been widely used to improve midfacial depression. However, most of the related studies focus on surgical techniques or filling materials, yet lack accurate and objective aesthetic evaluation. In the current study, we used 3D imaging to collect 3D facial profile of 66 patients suffering from midfacial depression. Related linear distance and angles were measured accurately using 3D software. Patient satisfaction and physician evaluation were also collected in the follow-up period. The results showed that patients' midfacial depression were significantly improved after the surgery and the overall patient satisfaction was 100%. Our study demonstrated the positive role of nasal base filling in improving the midfacial depression, and illustrated the advantages of 3D imaging technology in personalized preoperative communication, surgical simulation and postoperative effect evaluation.Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Maher DI, Hall AJ, Gwini S, Ben Artsi E. Patient-specific Implants for Orbital Fractures: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:417-424. [PMID: 34750315 DOI: 10.1097/iop.0000000000002089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Orbital fractures are common facial fractures that can be challenging to repair and require careful attention to avoid unacceptable ophthalmic complications. Customized implants that are unique to an individual patient, or patient-specific implants (PSIs), have been increasingly used to repair orbital wall fractures. This systematic review summarizes the current evidence regarding custom-made orbital wall implants. METHODS A keyword search of published literature from January 2010 to September 2021 was performed using Ovid MEDLINE, PubMed, and the Cochrane Library databases. Original articles that included more than 3 human subjects with an orbital fracture repaired with a PSI were included. The search results were reviewed, duplicates were removed and relevant articles were included for analysis. RESULTS Fifteen articles meeting the inclusion criteria. The articles were categorized into 3 separate groups based on the method of PSI fabrication: manual molding of a PSI on a 3D-printed orbital model (53%), directly from a 3D printer (27%), or via a template fabricated from a 3D printer (20%). Three primary postoperative outcomes were assessed: rates of diplopia, enophthalmos, and orbital volume. Postoperative rates of diplopia and enophthalmos improved regardless of the PSI technique, and postoperative orbital volumes were reduced compared with their preoperative state. When PSIs were compared to conventional implants, patient outcomes were comparable. CONCLUSIONS This review of existing PSI orbital implant literature highlights that while PSI can accurately and safely repair orbital fractures, patient outcomes are largely comparable to orbital fractures repaired by conventional methods, and PSI do not offer a definitive benefit over conventional implants.
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Affiliation(s)
- Dominic I Maher
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - StellaMay Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elad Ben Artsi
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
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Wang HD, Dillon J. Contemporary Management of Zygomaticomaxillary Complex Fractures. Semin Plast Surg 2021; 35:256-262. [PMID: 34819807 DOI: 10.1055/s-0041-1735812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.
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Affiliation(s)
- Howard D Wang
- The Craniofacial Center, Seattle Children's Hospital, Seattle, Washington.,Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington
| | - Jasjit Dillon
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
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Epstein S, Ettinger RE. Nasal and Naso-orbito-ethmoid Fractures. Semin Plast Surg 2021; 35:263-268. [PMID: 34819808 DOI: 10.1055/s-0041-1735791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Craniofacial fractures are common among trauma patients. Nasal fractures are the most common craniofacial fracture. Understanding how to evaluate and manage craniofacial fractures is important for the craniofacial trauma consultant. This manuscript describes the appropriate workup and management of nasal and naso-orbito-ethmoid fractures.
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Affiliation(s)
- Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Russell E Ettinger
- Division of Plastic and Craniofacial Surgery, Department of Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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Abstract
BACKGROUND The purpose of this study was to review the different types of maxillary fractures and highlight their diagnostic and therapeutic differences. METHODS A retrospective chart review of patients who sustained maxillary fractures was conducted through the Einstein Healthcare Network during the years 2016-2017. Descriptive statistics and chi-square analysis were used to categorize continuous and categorical variables, respectively. RESULTS The cohort of patients (n = 141) were predominately African American (62%) and male (75%) with a mean age 45.3 years. The most common maxillary fracture was maxillary sinus (29%), followed by zygomaticomaxillary complex (ZMC) (26%), frontal process (20%), dentoalveolar (16%), and LeFort (9%). Dentoalveolar fractures were mostly evaluated by the oral maxillofacial surgery service (74%), while ZMC and LeFort fractures were more commonly referred to an otolaryngologist (56% and 67%, respectively). Patients with dentoalveolar fractures were more likely to undergo wire splinting (61%). All patients with frontal process and maxillary sinus fractures were managed non-operatively. Most patients with ZMC fractures were managed non-operatively (78%) while the remainder underwent open reduction internal fixation (ORIF) (22%). Patients with LeFort fractures more commonly underwent maxillomandibular fixation (MMF)/ORIF (83%). Dentoalveolar fractures were the most likely to be operated on the same day (93%) while ZMC and LeFort fractures were repaired within 1 week (88% and 100%, respectively). CONCLUSION Maxillary trauma is very heterogenous in comparison to other maxillofacial trauma patterns. Each fracture type is treated uniquely and can involve one or more provider teams depending on the extent and severity of the injury, as well as hospital resources.
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Khajuria A, Osborne MS, McClleland L, Ghosh S. Improving the quality of assessment and management of nasal trauma in a major trauma centre (MTC): Queen Elizabeth Hospital, Birmingham. BMJ Open Qual 2019; 8:e000632. [PMID: 31803851 PMCID: PMC6887497 DOI: 10.1136/bmjoq-2019-000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background Nasal fractures present in 39% of patients with facial trauma. These patients are assessed in the emergency department followed by outpatient review in the senior house officer-led emergency ear, nose and throat (ENT) clinic. Inadequate treatment of nasal trauma can result in debilitating functional and aesthetic problems. Inexperienced junior doctors may be apprehensive in assessing nasal trauma resulting in time pressured clinics and suboptimal management. Measures A retrospective review of clinical noting over 3 months was carried out to gauge the extent of the problem. Three baseline measurements for satisfactory quality of assessments included: (1) 3/5 key symptoms elicited by the clinician (epistaxis, rhinorrhoea, nasal airway obstruction, dental malocclusion and diplopia). (2) Presence/absence of ‘septal haematoma’ (SH) and ‘deviated nasal septum’ (DNS) documented. (3) Patient follow-up within 2 weeks after the initial injury. Three Plan-Do-Study-Act (PDSA) cycles were conducted with implementation of interventions (proforma, clinic poster, patient information leaflet and training) as visualised in our ‘driver diagram’. Results The quality of nasal trauma assessments improved following each intervention. There was an increase from 86% to 100% patients being seen within 2 weeks of the injury. There was an improvement in quality of assessments following the teaching as two-thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) of clinical documentation included ‘rhinorrhoea’ and 83% (PDSA cycle 2) to 100% (PDSA cycle 3) included ‘nasal airway obstruction’. Similarly, two thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) examined and documented the presence/absence of SH and DNS. A 100% improvement in trainee confidence was reported. We are now conducting more comprehensive assessments of nasal trauma patients. Conclusion The need to provide relevant training and support to ENT junior doctors is crucial in their development, as well as to ensure delivery of high-quality patient-centred care.
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Affiliation(s)
- Apoorva Khajuria
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Max Sallis Osborne
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Lisha McClleland
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sandip Ghosh
- Diabetes and Endocrinology Department, Queen Elizabeth Hospital Birmigham, Birmingham, UK
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Sanjaya IGPH, Hamid ARRH, Adnyana IMS, Purwanthi IGAP, Magdalena P, Mardhika PE. Risk of Lower Eyelids Malposition in Subciliary Compared to Transconjunctival Approach in Maxillofacial Fractures Management: A Systematic Review and Meta-Analysis. Open Access Maced J Med Sci 2019; 7:2953-2957. [PMID: 31844463 PMCID: PMC6901874 DOI: 10.3889/oamjms.2019.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following those procedures is lower eyelids malposition. AIM: This meta-analysis will analyse which approach (subciliary and transconjunctival approaches) is more favourable to decrease lower eyelids malposition incidence. METHOD: This meta-analysis was conducted based on PRISMA guidelines. The electronic search was conducted using keywords (“Lower Eyelids Malposition” OR “Complications” OR “Ectropion” OR “Entropion”) AND (Transconjunctival) AND (Subciliary) AND (Maxillofacial Fractures) in PubMed, The Cochrane Library, and Directory of Open Access Journal (DOAJ). This review included full-text studies (observational and randomised controlled trials) in English comparing subciliary and transconjunctival approach in patients with maxillofacial fractures in the last 10 years. The data collected were the type of fractures and approaches, ectropion and entropion incidence as well as follow-up duration. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklist. Statistical analysis was done using Review Manager 5.3 (Cochrane, Denmark). RESULT: This study included 3 cohort studies and 2 Randomized Controlled Trial (RCT) studies from 2012 to 2017 with a total of 574 samples. Subciliary approach had a significant higher ectropion incidence when compared to transconjunctival approach (RR = 4.64, 95% CI: 1.68-12.81, p = 0.003). There was also a significant reduction of entropion incidence in patients with subciliary approach compared to transconjunctival approach (RR = 0.16, 95% CI: 0.04 – 0.69, p = 0.01). CONCLUSION: There was no superiority between one procedure toward another since each procedure related to different lower eyelids malpositions.
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Affiliation(s)
- I Gusti Putu Hendra Sanjaya
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Agus Roy Rusly Hariantana Hamid
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - I Made Suka Adnyana
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - I Gusti Ayu Putri Purwanthi
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Paulina Magdalena
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Putu Eka Mardhika
- Department of Neurosurgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
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Voß JO, Thieme N, Märdian S, Doll C, Hartwig S, Heiland M, Raguse JD, Adolphs N. [Frequency and management of complex facial fractures-an oral and maxillofacial surgical assessment]. Unfallchirurg 2019; 122:711-718. [PMID: 30783709 DOI: 10.1007/s00113-019-0618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The treatment of facial fractures is an integral part of the oral and maxillofacial surgical treatment spectrum. In the case of complex fractures that involve multiple levels of the facial skeleton associated with severe concomitant injuries, an individual and interdisciplinary treatment approach is needed, which requires the infrastructure of a national trauma center. OBJECTIVE The aim of this study was to analyze the incidence and management of patients with complex facial fractures and considering the concomitant injury pattern. MATERIAL AND METHODS A retrospective analysis of patients with complex facial fractures during the years 2009-2015 admitted to the emergency surgical department of a national trauma center was carried out. The identification of appropriate patient cases was based on the International Statistical Classification of Diseases and Related Health Problems (ICD) coding of electronic patient data. Only patients with at least a combination of mandibular and midfacial fractures (2-level fractures) were considered. Patients with mainly dentoalveolar fractures and simple nasal bone fractures were not included. The evaluation of the electronic medical records included the etiology, fracture pattern, associated severe injuries on the basis of the injury severity score (ISS), treatment regimen as well as the length of the hospital stay. RESULTS In the 7‑year study period, 3382 patients were identified with facial fractures. Of these, 128 patients (3.78%) presented with a complex fracture pattern with a combination of mandibular fractures and fractures of the midface. The majority of these patients (n = 92) had less severe concomitant injuries (ISS ≤ 16), while 36 patients showed severe concomitant injuries (ISS > 16). The incidence of a 3-level fracture involving the mandible, midface and anterior skull base was only 0.47% and could be detected in 16 patients, of which 10 were classified as polytrauma (ISS > 16). CONCLUSION The incidence of complex fractures of the facial skeleton was comparatively low with almost 4%. More than one in four patients with complex injury patterns of the facial skeleton exhibited severe concomitant life-threatening injuries, necessitating an interdisciplinary management with the specialized infrastructure of a nationwide trauma center.
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Affiliation(s)
- Jan Oliver Voß
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Nadine Thieme
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Sven Märdian
- Klinik für Orthopädie und Unfallchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Christian Doll
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Stefan Hartwig
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Johannes Wesling Klinikum Minden, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - Max Heiland
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Jan-Dirk Raguse
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Nicolai Adolphs
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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Abstract
Appropriate medical care for a patient with a facial fracture can not only optimize aesthetic outcomes but also prevent the potential morbidity and mortality of delayed treatment. In this article, we focus on the clinical presentations, physical examination findings, diagnostic imaging, consultations, and follow-up that patients with facial fractures need related to their emergency department management. Specifically, we address the nuances of evaluating frontal, orbital, nasal, maxillofacial, and mandibular fractures.
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Affiliation(s)
- Steve Chukwulebe
- Department of Emergency Medicine, Northwestern Medicine, Northwestern University Feinberg School of Medicine, 259 East Erie, Suite 1300, Chicago, IL 60611, USA
| | - Christopher Hogrefe
- Department of Emergency Medicine, Northwestern Medicine, Northwestern University Feinberg School of Medicine, 259 East Erie, Suite 1300, Chicago, IL 60611, USA; Department of Medicine, Northwestern Medicine, Northwestern University Feinber School of Medicine, 259 East Erie Street, Suite 1300, Chicago, IL 60611, USA; Department of Orthopaedic Surgery, Northwestern Medicine, Northwestern University Feinberg School of Medicine, 259 East Erie Street, Suite 1300, Chicago, IL 60611, USA; Department of Orthopaedic Surgery, 259 East Erie Street, Suite 1300, Chicago, IL 60611, USA.
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