Follow-up CT is indicated if fractures or sinus air-fluid levels are detected.May be used to rule out fractures in stable patients with low-moderate pretest probability of facial fracture.X-ray face (Waters or occipitomental view): if CT is not immediately available.To evaluate for continuity of orbital boundaries, sinus injuries, and soft tissue involvement.To determine the type and number of midfacial and mandibular fractures.High-resolution CT face (preferred modality): thin slices and 3D reconstruction.Ocular examination: indicated in Le Fort II, Le Fort III, and zygomaticomaxillary complex fractures to assess for ocular injury.Physical examination: Assess for midfacial and mandibular instability, cranial nerve deficits, and concomitant orbital, nasal, and/or dental injuries.Consider discharge with close outpatient follow-up in patients with isolated facial fractures who have no associated injuries, signs of airway compromise, or evidence of moderate TBI or severe TBI.Admit patients requiring surgical intervention, airway management, or observation (e.g., for moderate TBI, severe TBI, or delayed intracranial hemorrhage).Consider additional consults (e.g., ENT, ophthalmology, critical care) as needed.Consult oromaxillofacial surgery for definitive management.Open reduction or closed reduction with or without internal fixation.Intraoperative adjustment of dental malocclusion.Restoration of facial structures and proportions.Fractures with neurological, vascular, or ocular involvement.Conservative management: for nondisplaced fractures without vascular or neurological complications.For fracture-specific management: See “ Nasal fractures,” “ Zygomatic fractures,” and “ Mandibular fracture.” ![]() The following principles apply generally to facial fractures.
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