E2258. MAP the Face: Simplifying the Complex Facial Fractures in Relevance to Surgical Planning
Rajarama Ravivarma N;
Complex facial bone fractures are common in high velocity trauma like motorvehicle accidents.Traditionally, LeFort’s classification played an important role in classification of mid facial fractures, however, it is conceptualised based on low-speed trauma. Recently, more emphasis is laid on maxillary occlusion bearing segments which plays an important role in surgical planning. Radiology report based on this classification system helps in communicating clinically and surgically relevant findings. For example: Depressed zygomatic arch fractures can lead to restricted mouth opening. Frontal sinus posterior table fractures can lead to communication with anterior cranial fossa, presenting with CSF rhinorrhea, meningitis and intracranial hemorrhage.
Maxillary buttresses are divided into horizontal and vertical buttresses which are directly or indirectly connected with skull base or cranium. Fractures are classified into: a) Naso-orbito-ethmoid complex fractures which are based on involvement of medial canthal tendon, and disrupt the medial maxillary buttress. Orbital blow out fractures are most critical component in this group. b) Zygomatico-maxillary complex fractures disrupt two buttresses, the upper transverse maxillary buttress and lateral vertical maxillary buttress and are a result of direct impact on the malar eminence. c) Frontal bone fractures tend to disrupt the frontal bar and superior orbital rims, d) Mandibular fractures can disrupt both the horizontal and vertical buttress(posterior mandibular and upper, lower transverse mandibular). They can be classified into favourable and unfavourable fractures in the horizontal or vertical plane, based on the muscle pull on the fracture fragments.
Educational Goals / Teaching Points
To categorize various facial bone fractures in relation to facial buttress system and derive a simplified reporting template.
To enumerate most important fractures to be included in the radiology report which can result in immediate as well as delayed complications.
To discuss role of Multidetector Computed Tomography with multiplanar reconstruction and surface rendering in surgical planning.
To discuss application of 3D printing in pre-operative planning of maxillofacial fractures.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Plain radiographs are primary imaging modality, however, it is limited by detail inaccuracies related to the superimposition of adjacent anatomic structures. Multidetector computed tomography (CT) with 3D reconstruction is the modality of choice for maxillofacial fracture evaluation. CT is also helpful for 3D printing, which is commonly used for pre-operative orbital floor mesh repair planning.
This educational exhibit helps the reader to adapt a reporting template based on the four facial buttresses, simplifying the reporting process as well as communicating clinically and surgically relevant findings.