Management of Facial Fractures

Multidisciplinary Consultation Requirements

Neurosurgery consultation is required when intracranial injury is present, which occurs in 68% of patients with facial fractures, and is specifically indicated for orbital wall fractures, as 9% have concomitant intracranial injury 1
Ophthalmology consultation is mandatory for orbital fractures to assess visual acuity, extraocular movements, and globe integrity 2
Up to 37% of patients with orbital fractures develop diplopia postoperatively, according to the American College of Radiology 3
Infraorbital nerve involvement requires documentation, as recommended by the American College of Radiology 4
Cervical spine injury occurs in 7-11% of patients with significant maxillofacial trauma, and the American College of Radiology recommends consideration of this injury in trauma patients 1, 5

Otolaryngology (ENT) consultation should be considered for frontal sinus fractures and complex nasoethmoidal-orbital injuries, as recommended by the American College of Radiology 2
ENT may assist with airway management in severe midface trauma, according to the American College of Radiology 2

CT maxillofacial imaging is essential for surgical planning, as plain radiography misses 12% of fractures, and the American College of Radiology recommends CT maxillofacial without contrast 4

Cervical spine clearance is essential, as 11% of mandibular fracture patients have concomitant cervical spine injury, according to the American College of Radiology 5