Adult facial Fractures: A review and guide for emergency medicine clinicians

Background

Facial fractures are common injuries in emergency departments across the United States. These can present various challenges for emergency medicine (EM) physicians and other healthcare providers. Managing these injuries can be complex which may be exacerbated by varying availability of specialist support, particularly in rural or community settings.

Objective of review

This review aims to provide a comprehensive, evidence-based approach to the management of facial fractures for emergency medicine (EM) clinicians. This review highlights key principles in trauma evaluation, imaging, and indications for surgical consultation to improve decision-making and patient care.

Discussion

Facial fracture management begins with systematic trauma evaluation, prioritizing stability, hemorrhage control, and airway patency. Maxillofacial CT without contrast is the preferred imaging modality for most facial fractures with some requiring further imaging. Emergency physicians should recognize high risk features requiring surgical consultation, including displacement, malocclusion, and neurovascular compromise. Orbital and midface fractures may require ophthalmologic consultation if the patient presents with entrapment, globe rupture, or orbital compartment syndrome. In many cases, stable, non-displaced fractures may be managed outpatient with clear return precautions and outpatient surgical follow-up.

Conclusion

This review is designed to be accessible and instructive for EM trainees and clinicians. These multidisciplinary guidelines provided can equip EM providers with the knowledge to safely and effectively triage facial fractures.