E2894. Blow by Blow: A Detailed Review of Facial Trauma Imaging
  1. Sungmee Park; University of California, Irvine
  2. Katherine Wei; University of California, Irvine
  3. Bradley Roth; University of California, Irvine
  4. Jeanette Meraz; University of California, Irvine
  5. Riya Bansal; University of California, Irvine
  6. Roozbeh Houshyar; University of California, Irvine
  7. Edward Kuoy; University of California, Irvine
Facial and temporal bone fractures are some of the most frequently encountered traumatic injuries in the emergency department and may frequently fall in predictable patterns. Facial fractures are some of the most common injuries worldwide and can result in irreversible damage and/or disfigurement. Understanding the mechanisms underlying these fracture patterns as well as their potential complications is essential to conveying radiological findings in an effective manner to clinicians, and thus guiding patient management. With this goal in mind, we will discuss several complexes and surgically relevant classification systems of facial and temporal bone trauma and elaborate upon important complications that can be seen with specific types of injuries.

Educational Goals / Teaching Points
Our objective is to provide an in-depth overview of common facial fracture patterns and important sites of involvement to look for in temporal fractures. We will review surgically relevant classification systems and discuss important clinical complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will give a brief overview on the major anatomic landmarks of the facial and temporal bones with attention to areas that are important to assess in the trauma setting. The most frequently encountered facial fracture complexes include the Le Fort midface fracture complexes, the zygomaticomaxillary complex (ZMC), and the naso-orbito-ethmoidal (NOE) complex. The Le Fort I, II, and III fractures can be broadly described as the “floating palate”, “floating maxilla”, and “craniofacial dissociation,” respectively, with all three fracture complexes involving the pterygoid plates. Malocclusion is a frequent complication of Le Fort fractures. ZMC fractures involve four sites of injury — the lateral orbital rim, inferior orbital rim, zygomaticomaxillary buttress, and the zygomatic arch. Complications that can be seen with ZMC fractures include facial asymmetry, enophthalmos, and restricted mouth opening from coronoid impingement. NOE fractures typically result from high-energy blunt trauma and can coexist with ZMC and panfacial fractures. The most important complication which can result from a NOE fracture is disruption of the medial canthal tendon, which may result in hypertelorism. Temporal bone fractures can be broadly classified into transverse and longitudinal orientations, although pinpointing important sites of involvement including the carotid canal, otic capsule, facial nerve canal, tegmen, and ossicular chain is more clinically relevant.

When encountering facial and temporal bone fractures, it is important to recognize the potential patterns of involvement and key sites of involvement that may alter a patient’s clinical course.