An approach to mid-facial fractures

The purpose of this article is to present a concept which facilitates the plain film identification of mid-face fractures. The concept evolves from a logical classification of mid-face fractures based upon the region(s) of involvement (orbit, zygoma, maxilla), the extent of the fractures (unilateral or bilateral) and the characteristic distribution of the fracture lines. Recognition of these fractures depends upon an awareness of the fact that the radiographic signs of mid-face fractures differ in certain respects from those involving other skeletal parts. In addition to skeletal disruption, the radiographic signs of mid-face fractures include soft tissue abnormalities which may be localized or diffuse, and which may be either extrinsic or intrinsic to the facial skeleton, alterations of normal skeletal contour, the "bright white line" of displaced fragments, and the subcutaneous emphysema which may also be localized or diffuse. The application of this concept to the roentgen diagnosis of mid-face fractures will be described and illustrated.