Facial Butress System

RC 01 HN-03 Diagnostic imaging of the face and jaw
Head and Neck Oct 10, Fri
09:00-09:30
Grand Ballroom 102
Chairperson(s) : Dong Woo Park Hanyang University Guri Hospital, Korea

Dae Seob Choi Gyeongsang National University Hospital, Korea
Key concepts in facial trauma

Jin Woo Choi
Konkuk University School of Medicine, Korea. cardijin@gmail.com
according to the area of interest on a case by case basis.
1. Introduction
Facial trauma accounts for the majority of emergency
department visits in urban area. Motor vehicle accidents,
assault, falls, and sports account for a majority of facial
trauma. Many of these patients have imaging studies for
injuries not apparent by direct inspection. The primary
role of imaging studies in the facial trauma is to classify
the facial trauma by defining the number and location of
known facial fractures, to identify additional fractures that
are missed by physical examination, and to evaluate
combined soft tissue injury. Moreover, radiologists must
pay special attention to identify combined life-threatening
conditions such as injuries in the brain, spine and airway.
2. Imaging Techniques
Plain radiographs were considered standard imaging
for facial trauma. However, the superimposition of facial
bony structures and air-containing structures such as
paranasal sinuses and airways made interpretation of
facial bone fracture inaccurate and difficult on plain
radiographs. Moreover, plain radiographs do not provide
sufficient information to assess injury severity and
displacement of the facial bone fracture, which are
essential for emergent management and surgical
planning. In addition, radiographic positioning is timeconsuming, difficult and potentially dangerous for multitrauma patients suspected cervical spine injury.
Multidetector CT (MDCT) scanners have revolutionized
trauma imaging and provide a fast, safe, cost-effective,
and sensitive means for assessing trauma for bone and
soft tissue injuries. Furthermore, with the advent of
MDCT, facial scans can now be performed
contemporaneously with head, thoracic, and abdominal
scans, facilitating a rapid assessment for trauma patients
with multiple potential injuries. Scanning is acquired at
submillimeter thickness with overlap to generate highquality multiplanar reformations and 3-D reconstructions.
The routine scan range should be from the frontal sinus
to hyoid bone for including basal skull, mandible and
upper cervical spine. CT images are reviewed at 2 or 3mm thick axial or coronal multiplanar reformations, and
additional sagittal reformations are also generated
3. Facial Bone Anatomy and

Facial Buttress System
The facial skeleton is a complex structure formed by a
combination of five paired bones and four unpaired
bones. The anatomic relationship between these facial
bones is complex. In spite of the complexity of the facial
anatomy, pointing out the individual facial bone such as
zygoma, palatine, maxillary and sphenoid bone is
essential to interpret radiological images and to
communicate with clinicians. In addition, the facial
anatomy should be understood in terms of facial bones,
adjacent soft tissue and organ, and functionally relevant
structures. The facial skeleton can be conceptualized as
four transverse and four paired vertical buttresses. The
vertically oriented struts directly or indirectly connect the
anterior facial skeleton to the posterior skull base. The
greater thickness of bone in the facial buttresses, both
horizontal and vertical, with respect to the remainder of
the facial skeleton provides a rigid protective framework
for the orbital contents, sinuses, teeth, and nasal cavity.
Disruption of the facial buttresses can change facial
dimensions and alter normal function, necessitating
surgical fixation for restoration.
4. Classification of the Facial Bone Fracture

There are several classifications for facial fractures. By
anatomic location of bony injuries, facial fractures can be
classified into limited fractures, transfacial fractures, and
smash fractures. Limited fractures can involve only one
buttress strut (simple fractures) or two adjacent
buttresses struts (complex fractures). The examples of
the simple fractures are nasal bone, maxillary alveolar,
zygomatic arch, localized sinus wall and mandibular
fracture. The complex fractures include nasofrontal,
nasomaxillary, nasoethmoidal, zygomaticomaxillary
complex, and malar(tripod) fracture. A transfacial fracture
involves the pterygoid plates by definition, and this
includes classic Le Fort fracture. A smash fracture is a
severely comminuted fracture that does not follow the
pattern of a traditional transfacial fracture, this includes
naso-orbital-ethmoidal fracture. In another classification
These compartments were grouped into nasal, orbital,

zygomatic, maxillary and mandibular regions.
In this refresher course, I will provide an overview of
the facial skeletal anatomy and describes the system of
facial buttresses. Next, the spectrum of fractures that
may be seen in facial skeletal trauma is described.
Critical imaging features that may be seen and that are
likely to have a bearing on the clinical management,
surgical repair, and outcome of facial trauma are
discussed. Last, surgically relevant complications that are
predictable on the basis of the fracture pattern seen at
imaging are reviewed according to the facial buttress
affected by fracture.
Head and Neck Oct 10, Fri
system that is used by surgeon, the osseous facial

anatomy is divided into upper, middle, and lower thirds.
The upper third of the face consists of the frontal bone
above the superior orbital rims and walls. The middle
third of the face extends from the superior orbital rims
inferiorly to the maxilla and thus includes the orbits; the
nasal cavity; and the maxillary, ethmoid, and sphenoid
sinuses. The lower third of the face consists of the
mandible. Classifying fractures by their location with
regard to these facial thirds may be helpful for planning
surgical access. Another way of classifying facial bone
fracture is anatomic grouping of the adjacent and
functionally relevant facial bone as one compartment.

Facial Butress System

Uploaded by

Copyright:

Available Formats

Facial Butress System

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Facial Butress System

Uploaded by

Copyright:

Available Formats

RC 01 HN-03 Diagnostic imaging of the face and jaw

Head and Neck Oct 10, Fri

Grand Ballroom 102

Chairperson(s) : Dong Woo Park Hanyang University Guri Hospital, Korea

Key concepts in facial trauma

according to the area of interest on a case by case basis.

3. Facial Bone Anatomy and

4. Classification of the Facial Bone Fracture

These compartments were grouped into nasal, orbital,

Head and Neck Oct 10, Fri

system that is used by surgeon, the osseous facial

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.