Some facial fractures require immediate consultation and necessitate transfer due
to specialist unavailability. Up to 90% of mid-face fractures have associated ocular
injuries.
1
Fracture of one or more of the seven orbital bones constitute nearly 25% of IFF and
warrant immediate ophthalmologist consultation, especially in the setting of ruptured
globe, visual changes, or impaired ocular motion. If cleared by ophthalmology, the
vast majority of these isolated facial fractures can safely follow up with a maxillofacial
surgeon within one week and only 15% of these patients will ultimately require operative
intervention in an elective setting.
1
Other indications to consider urgent specialist consultation include penetrating
IFF, abnormal neurologic exam, and some displaced Lefort fractures.
2
CT angiogram should be considered for complex facial fractures as up to 10% are found
to have concomitant cervical spine injury and/or vessel injury requiring intervention.
3
Although clear guidelines are not yet solidified, it has been demonstrated that trauma
surgeons are capable of safely triaging CMF trauma with equivalent in-hospital mortality
and 30-day readmission regardless of the decision for CMF consultation.
4
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References
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Article info
Publication history
Published online: October 18, 2022
Accepted:
October 14,
2022
Received:
October 13,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
