Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents following high-energy facial trauma. Reports significant midface mobility, malocclusion, and periorbital ecchymosis. Denies loss of consciousness, but notes persistent epistaxis and CSF rhinorrhea. History of present illness consistent with craniofacial dysjunction.
Clinical Examination Findings
Physical exam reveals "dish-face" deformity, bilateral circumorbital ecchymosis (raccoon eyes), and significant mobility of the entire midface complex relative to the cranial base upon manipulation. Intraoral exam shows anterior open bite and bilateral step-off at the zygomaticofrontal sutures. Neurological status stable; cranial nerves II-XII grossly intact.
Treatment Protocol
Immediate airway stabilization and cervical spine precautions initiated. Surgical management involves Open Reduction and Internal Fixation (ORIF) of the naso-orbito-ethmoid and zygomaticomaxillary complexes. Rigid internal fixation with titanium plates and screws. Post-operative management includes prophylactic antibiotics, corticosteroids to reduce edema, and intermaxillary fixation (IMF) as required.