[Fractures of the facial skeleton]

The radiologist is in the unique position of reviewing the management of facial fractures when interpreting the post reduction films. Many of these patients have other more life threatening injuries so that their facial fractures may have been neglected or treated by individuals unfamiliar with the problem of facial injury. Immobilization following reduction is the key to satisfactory healing. The bony calvarium is the pivotal point and all free fragments should be immobilized to the frontal zygomatic area. Mandibular fractures should be immobilized to the upper alveolar ridge. If the upper alveolar ridge is also a free fragment due to a LeFort type fracture the entire complex of mandible and midface after being wired together should be wired to the stable bony calvarium. Midface fractures (LeFort type fractures) require the same type of treatment as one would apply to a forearm fracture; i.e., the joints proximal and distal must be immobilized. In the midface fracture the mandible is immobilized through the teeth to the upper alveolar ridge and the entire complex to the bony calvarium. The more specific problems associated with individual factors require high quality radiographic techniques for diagnosis and management.