Evaluation of Maxillofacial Trauma
Clinical Assessment
- The American College of Radiology recommends evaluating occlusion as an essential component of secondary face evaluation, including palpation, visual inspection, and cranial nerve assessment, after patient stabilization 2
- Malocclusion is a direct indicator of midface and mandible injury, consistently mentioned in the American College of Radiology guidelines as a primary clinical sign to be evaluated in maxillofacial trauma assessment 1, 2
- Malocclusion is a specific indicator for midface injury involving the zygoma, maxilla, and mandible, indicating displacement or fracture of skeletal structures 1
- Facial elongation or malocclusion is a clinical sign that triggers suspicion of midface injury, according to the American College of Radiology 3
Differential Diagnosis
- Anisocoria is more indicative of neurological injury or cranial trauma, rather than being specific to skeletal face trauma 2
- Diplopia is a complication of orbital fracture (blow-out fracture) due to entrapment of extraocular muscles or periorbital edema, rather than a primary skeletal sign 4
- Diplopia occurs in up to 37% of patients post-operatively with orbital fractures, indicating it is a secondary consequence of trauma, not a primary indicator 4
Management
- The primary goal of management is to restore function and cosmetics, and accurate diagnosis through occlusion assessment makes this goal achievable 2