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  • Cited by 1
  • Print publication year: 2008
  • Online publication date: January 2010

27 - Oral and Maxillofacial Trauma

    • By Ketan P. Parekh, Department of Oral and Maxillofacial Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Cecil S. Ash, Department of Oral and Maxillofacial Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Publisher: Cambridge University Press
  • DOI:
  • pp 417-430



Review the pathophysiology of maxillofacial trauma.

Discuss the surgical considerations for patients with facial trauma, including fractures of the upper and lower jaws, orbits, facial lacerations, and midface fractures (LeFort fractures).

Review the implications of head and neck infections including Ludwig's angina.


Oral and maxillofacial surgeons (OMSs) are the surgical specialists of the dental profession. Their surgical expertise and thorough understanding of both aesthetics and function uniquely qualify them to diagnose, treat, and manage the conditions, defects, injuries, and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial regions.

As an oral and maxillofacial surgeon, extensive dental and medical training in the hospital-based environment is needed to treat and repair injuries to the face. OMSs are experts in treating facial trauma, including fractures of the upper and lower jaws and orbits and the cosmetic management of facial lacerations. As an OMS, responsibilities also extend into performing complex reconstruction of the maxillofacial and craniofacial complexes.

Important to the training of the OMS is the acquisition of knowledge and skill in advance and complex pain control methods, including intravenous (IV) sedation and ambulatory general anesthesia. An OMS resident receives up to 6 months of operating room (OR) general anesthesia experience alongside board-certified medical anesthesiologists. In addition, the OMS receives extensive training and experience in the initial and definitive care of the trauma patient, management of extensive odontogenic infections of the head and neck, management of oral pathologic lesions (such as cysts and tumors of the jaws), diagnosis and management of dentofacial deformities (congenital, developmental, or acquired), complex maxillofacial preprosthetic surgery (including the use of dental implants), reconstruction with bone grafts of missing portions of the jaws, and management of facial pain and temporomandibular joint disorders.

Assael, L, Klotch, D, Manson, P, Prein, J, Rahn, B, Schilli, W. Manual of Internal Fixation in the Cranio-Facial Skeleton. Berlin, Heidelberg, New York: Springer-Verlag, 1998.
Bailey, BJ, Prater, M. Mandible fractures. In Online Textbook of Otolaryngology. November 27, 1996.
Bailey, BJ. Head and Neck Surgery – Otolaryngology, Mandible Fractures. Philadelphia, PA: J.B. Lippincott, 1998, pp 977–88.
Banks, P, Brown, A. Fractures of the Facial Skeleton. London: Butterworth-Heinemann Medical, 2001, pp 152–7.
Choung, R, et al. A retrospective analysis of 327 mandibular fractures. J Oral Maxillofac Surg 1983 May;41(5):305–9.
Dolan, KD, Jacoby, CG. Facial fractures. Semin Roentgenol 1978; 13: 37–51.
Dolan, KD, Jacoby, CG, Smoker, WR. The radiology of facial fractures. Radiographics 1984; 4: 575–663.
Ellis, E. Treatment methods for fractures of the mandibular angle, J Craniomaxillofac Trauma 1999; 28: 243–52.
Ellis, E, et al. Lag screw fixation of mandibular angle fractures. J Oral Maxillofac Surg 1991; 49: 234–43.
Fonseca, RJ, et al. Oral and Maxillofacial Trauma. Philadelphia, PA: W.B. Saunders, 1991, pp 359–405.
Fonseca, RJ, Walker, RV. Oral and Maxillofacial Trauma. Philadelphia, PA: W.B. Saunders, 1991, pp 576–99.
Gates, GA. Current Therapy in Otolaryngology – Head and Neck Surgery, Mandible Fracture, 6th edition. Philadelphia: Mosby, 1998, pp 150–2.
Har-El, G, et al. Changing trends in deep neck abscesses. Oral Surg Oral Med Oral Pathol 1994; 77(5):446–50.
James, RB. Prospective study of mandibular fractures. J Oral Surg 1981; 39: 275.
Hall, MB. Condylar fractures: Surgical management. J Oral Maxillofac Surg 1994; 52: 1189–92.
Haug, RH, Buchbinder, D. Incisions for access to craniomaxillofacial fractures. Atlas Oral Maxillofac Surg Clin N Am 1993; 1(2): 1–29.
Hiatt, JL, et. al. Textbook of Head and Neck Anatomy. 2nd ed. Baltimore, MD: Williams & Wilkins, 1987, pp 103–5.
Hoffman, WY. Rigid internal fixation vs. traditional techniques for the treatment of mandible fractures. J Trauma 1990; 30: 1032–5.
Marciani, RD, et al. Therapy of mandibular angle fractures. J Oral Maxillofac Surg 1994; 52: 752–6.
Marlow, TJ, Goltra, DD Jr, Schabel, SI. Intracranial placement of a nasotracheal tube after facial fracture: A rare complication. J Emerg Med 1997; 15(2):243–4.
Mathog, RH. Atlas of Craniofacial Trauma. Philadelphia, PA: W.B. Saunders, 1992, pp 25–119.
Muzzi, DA, Losasso, TJ, Cucchiara, RF. Complication from a nasopharyngeal airway in a patient with a basilar skull fracture. Anesthesiology. 1991; 74(2):366–8.
Peterson, LJ, Ellis, E, Hupp, JR, Tucker, MR. Contemporary Oral and Maxillofacial Surgery, 4th edition. St. Louis, MO: Mosby Publishing, 2003, pp 343, 509–27.
Miloro, M. Peterson's Principles of Oral and Maxillofacial Surgery. Hamilton, Ontario: BC Decker, 2004, pp 401–3.
Walker, R. Condylar fractures: Nonsurgical management. J Oral Maxillofac Surg Nov 1994; 52(11):1185–8.
Warner, ME, Benenfeld, SM, Warner, MA, Schroeder, DR, Maxson, PM. Perianesthetic dental injuries. Frequency, outcomes, and risk factors. Anesthesiology 1999; 90: 1302–5.