Facial trauma is the most common pathology in cranio-maxillo-facial surgery. The facial or craniofacial trauma is often part of most complex polytrauma in which many specialists such as Orthopaedic, Neurosurgeon, Ophtalmologist, Anaesthetist, Pediatrician, General Surgeon, ENT can be called for. On the other hand, whenever possible, facial fractures should be operated on as soon as possible. The Team approach is mandatory for a comprehensive treatment of the patient in order to obtain morphological, functional and social rehabilitation If other more vital assessments and/or surgeries have priority, the maxillo facial treatment must be post-poned. In trauma each bone of the facial mass and skull can be involved as well as soft tissue.
The fractures may be isolated or combined (i.e. naso-orbital or maxillo-mandibular fractures). The aetiology is multifactorial: traffic accidents, sports, battered child, strokes, altercations, war injuries, gunshot wounds.
The symptoms depend on the involved area. A maxillo-mandibular fracture will result in a malocclusion. An orbital fracture with involvement of the floor and a periorbital prolapse (so called blow-out fracture) is characterized by diplopia and residual deformities such as enophthalmos and, in some complicated cases, visual loss owing to a direct trauma on the optic nerve. On the contrary in blow-in fracture, the walls are in-fractured and results in exophthalmos.
Untreated zygomatic arch fracture, may result in functional limitation with trismus due to interference between the mandibular coronoid process and the fractured zygomatic arch.
Another challenging field is the correction of the traumatic sequelae with facial residual deformities and disfigurements. Correction include osteotomies, ostectomies, bone grafting harvested from cranium or iliac crest, or more rarely by using biomaterials.