Published on 01/04/2015 by admin

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Last modified 01/04/2015

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The standard radiographs19

Midface and Orbit: one or two OM views; occasionally with a lateral view.

Mandible: OPG, preferably with a PA view.

Normal anatomy: midface & orbit

Occipitomental (OM) views


Analysis: the checklists

Midface injury

The midface anatomy appears very complex. Try this approach. Think of the zygoma (malar bone) as a midface stool with four legs. The seat of the stool is very strong. The four legs are much weaker, so you need to assess each leg very carefully.

A five-point checklist

Inspect the OM views as follows:

Concentrate on the stool’s legs. For each leg compare the injured side with the other (normal) side. Look for any asymmetry or any difference between the appearance of the matching legs. Check as follows:

Always apply this rule: If any one of the legs is fractured then always, always, double check whether the other three legs of the midface stool are intact (see Tripod fracture, p. 63).

Midface stool—Leg 4

Lateral wall of the maxillary antrum (arrow).

Normal radiograph.


Why we do not refer to Le Fort fracture patterns

Fractures of the middle third of the face are often classified according to the Le Fort fracture patterns3,4,1013. This is a useful classification for the maxillofacial surgeon when planning treatment. However, the Le Fort patterns are not particularly helpful when carrying out a step-by-step assessment of the plain radiographs in the Emergency Department. This is because the Le Fort patterns involve the pterygoid plates and the precise detail is only reliably provided by a CT scan with reconstruction of the CT images13. Designating a precise Le Fort injury pattern (if present) is at best guesswork when assessing plain radiographs.

Suspected blow-out fracture

Evaluate the OM view (see p. 66).

Injury to mandible

Evaluate the OPG view (see pp. 68–70).

The common injuries

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