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Fractures of the Condylar Process of the Mandible

Background Approximately 11%–50% of all facial fractures and 30%–40%% of all mandibular fractures (MFs) are fractures of the mandibular condyle. Most are not caused by direct trauma, but follow indirect forces transmitted to the condyle from a blow elsewhere, usually in the body or symphysis region. They are often the result of rapid deceleration injuries such as when the chin of an unrestrained passenger in a…

Mandible Fractures

Background The earliest descriptions referencing the management of mandible fractures date back to Ancient Egypt (1650 BC) in which the pathology was described as incurable, inevitably resulting in infectious complications, and leading ultimately to demise. Hippocrates would revolutionize the management with his introduction of the concepts of reduction and stabilization with circumdental wiring and external bandages for stabilization, similar to the technique of “bridle wiring” still…

Le Fort Fractures

Background Injury to the midface can have significant aesthetic and functional sequelae. The bony skeleton serves as a framework that aids in respiratory, ocular, vocal, olfactory, and digestive functions. Normal anatomy and symmetry of the midface is integral to social recognition and perception. Injury to the midface can involve a complex constellation of the skeletal anatomy: the maxillary and zygomatic processes of the frontal bone, nasal…

Orbitozygomaticomaxillary Complex Fractures

Background Because of its prominent position, the zygoma is one of the more frequently injured facial bones. The zygomatic bone is an essential structure of the midface and serves as a foundation, contributing greatly to both form and function. Fractures of the zygoma occur independently and in association with fractures to adjacent bones, such as Le Fort fractures. Since the zygoma constitutes most of the lateral…

Naso-orbito-ethmoid (NOE) Fractures

Background The naso-orbito-ethmoid (NOE) region of the central face is defined by the orbits laterally, the glabella superiorly and the nose inferiorly. It is a particularly challenging region of the face to reconstruct due to its aesthetic prominence, its 3-dimensional contour and the delicate associated structures involved in the region. NOE fractures occur from direct blunt force trauma to the central face, such as striking the…

Nasal Fractures

Background Nasal bone fractures are the most common type of facial bone fracture, accounting for at least half of all adult facial fractures. The annual incidence of nasal bone fracture ranges from 0.053% to 0.37%, with peak incidence in adolescence or early adulthood. Most nasal fractures are due to accidents (41%), with assault (31%) and sports (29%) also prominent etiologies. Nasal bone fractures are frequently associated…

Orbital Fractures

Background Orbital fractures are among the most common facial fractures, and their associated cost to the healthcare system has been on the rise. Surgical repair of orbital fractures has been shown to add a day of hospitalization and an average of $22,000 in hospital charges for the average trauma patient. Treatment of orbital trauma at high-volume specialized eye centers has been shown to reduce cost compared…

Endoscopic Approaches to Frontal and Maxillary Sinus Fractures

Background The paranasal sinuses are aerated spaces in the middle and upper third of the face that develop during the first and second decades of life in the frontal, ethmoid, maxillary, and sphenoid bones. The theoretical role of these structures in facial trauma is to provide shock absorption and dispersal of forces in order to prevent more severe injuries to critical anatomical structures such as the…

Frontal Bone and Frontal Sinus Injuries

Background The frontal sinus is protected by thick cortical bone. High-velocity impacts can result in frontal sinus fracture and brain injury. These complex injuries pose many surgical challenges and can be associated with long-term sequelae such as mucocele and meningitis. Optimal management strategies remain controversial. Treatment goals should include protection of the intracranial contents, avoidance of short- and long-term complications, restoration of an aesthetic frontal contour,…

Diagnosis and Multimodality Management of Skull Base Fractures and Cerebrospinal Fluid Leaks

Background History The description, diagnosis, and management of skull base cerebrospinal fluid (CSF) leaks has a long, controversial history dating back to the first report of this entity in the 17th century by Bidloo. In his report, the Dutch surgeon described a case of profuse posttraumatic CSF rhinorrhea that resulted in the death of his patient 7 months later from meningitis. Then, in the late 1800s,…

Traumatic Facial Nerve Injury

Introduction The field of facial paralysis provides the reconstructive surgeon an incredible opportunity to help patients with what is undoubtedly a devastating injury. The field intricately involves restoration of function, form, and even emotion, demanding that the surgeon use a wide spectrum of surgical tools and principles, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery with the goal of restoring the patient's appearance, as feasibly…

Primary Repair of Soft Tissue Injury and Soft Tissue Defects

Background Reconstruction of soft tissue craniofacial trauma represents a challenging and common problem. The soft tissue structures of the head and neck contain complex 3-dimensional geometry spanning across multiple subunits and structures. Each anatomic region requires careful attention in its repair to meet exacting aesthetic and functional demands. No other region of the body is as scrutinized during social interaction as the face, where even minute…

Intraoperative Imaging and Postoperative Quality Control

Background The idea behind intraoperative imaging is to avoid postoperative imaging and secondary revision procedures by allowing the intraoperative confirmation and adjustment of fracture reduction and hardware placement as necessary. This should save time, resources, reduce the number of operations, and improve results. Different imaging modalities are available intraoperatively, including magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US), and cone beam computed tomography (CBCT). Today,…

Radiological Evaluation of the Craniofacial Skeleton

Background It was the discovery of X-rays by Wilhelm Roentgen in 1895 that allowed visualization of the internal structures of the body for the first time in history. In 1972, an electrical engineer, Godfrey Hounsfield, advanced the use of X-rays with the invention of computed tomography, allowing the complete visualization of the internal solid organs, soft tissues, and bones of the body using image reconstruction mathematics.…

Assessment of the Patient With Traumatic Facial Injury

Background Incidence of Facial Trauma in the United States and Worldwide The spectrum of facial trauma includes soft tissue and bone, and ranges from the simple to the complex. Epidemiology varies with local and global demographic factors and reflects a complex interplay of influences, including those related to the environment, economics, age, gender, and mechanism of injury. Any understanding of the incidence of facial trauma is…

Cervicofacial Fat Reduction and Augmentation

If one were to read this textbook from cover to cover and write down 10 important facts that they have gleaned from these chapters, one of these would be the importance of fat for not only youthful appearance, but also the caution of removing excessive fat during cosmetic procedures. Fat provides youthful volume, and loss of fat causes deflation with aging ( Fig. 15.1 ). Understanding…

Chemical Peels

Introduction Chemical peels are a method of skin resurfacing to address a variety of patient concerns from dyschromias to acne scars and wrinkles. Many physicians may have switched from chemical peels to the ease of dialing in settings on their lasers to resurface skin. However, it is the author’s belief that with the proper understanding of peel-tissue interaction, one can selectively resurface various parts of the…

Laser Skin Resurfacing

In writing the third edition of this book, it is amazing how some chapters change significantly, and others remain more similar. This chapter on laser skin resurfacing (LSR) has changed dramatically because the past 15 years have ushered in technological advances as well as improved and more predictable treatment protocols. Lasers by definition are destructive devices and when used properly can create some of the most…

The Importance of Priming the Skin for Skin Resurfacing Procedures and Overall Anti-Aging

Introduction Many patients have tried a myriad of skincare products by the time they present to our offices, oftentimes with mixed results. It is not unusual for these patients to see little to no improvement in their skin or to develop an adverse reaction to a product they applied to their skin. As cosmetic surgeons, our role should be to address their concerns in both a…