**3.1 Preliminary data**

First, we have to secure the airway. Then, control nasal bleeding and other hemorrhages at the level of head and neck (**Figure 3**). Exclude any lesion at the level of the cervical spine. Also, check for any other occult life-threatening lesions such as spleen ruptures. This implies a second top-to-toe complete evaluation in 48 hours from the admission time and before any surgical interventions at the level

**89**

ment outcome [21].

**Figure 3.**

territory [22].

**3.3 Treatment plan in craniofacial trauma cases**

mas, nasal CSF leak, high fever, and thoracic concussions [23].

**3.4 Specific considerations regarding the midface trauma**

*Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics…*

of the head and neck along with a complete inventory of all the lesions presented by the patient. Moreover, question the patient if possible or the relatives about prior associated pathology which could have an essential role in the prognosis and treat-

*CT scan performed for a nasal vault concussion without fracture of the nasal bones but with a fracture at the* 

*level of the ethmoid perpendicular plate associated with CSF leak (accidental fall on the stairs).*

**3.2 Clinical signs requiring a dynamic evaluation in the early stage of admission**

Some clinical signs are requiring recurrent analysis during the early time of admission of multiple trauma patients: state of consciousness or drowsiness, increase in facial hematomas, increase pressure in orbital hematomas, high fever, the appearance of CSF at the level of the nasal cavity or the external ear canal, double vision, aggravation of mastication impairment, and loss of sensitivity in trigeminal nerve

This sequence of steps should focus on repairing all the lesions with full restoration of function and the esthetic aspect before the trauma. The therapy plan should focus initially on clinical signs and secondarily on the CT exam. Global management of the case should benefit from the input of various specialists such as ICU specialists, anesthesia specialists, and surgeons from all other backgrounds available in the healthcare unit on call. Recent photos of the patient along with dental X-rays before trauma may be useful in lesion assessment and clear future legal aspects. Surgical interventions may be postponed due to increasing facial hemato-

In cases with severe deformity, our experience recommends avoiding a conservative approach via small multiple regional "conservative/cosmetic" incisions. For

*DOI: http://dx.doi.org/10.5772/intechopen.92862*

*Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics… DOI: http://dx.doi.org/10.5772/intechopen.92862*

#### **Figure 3.**

*Trauma and Emergency Surgery - The Role of Damage Control Surgery*

pterygoid plate, and zygomatic arch [16].

**to the bones involved**

**Figure 2.**

*reconstruction with titanium plates.*

**3.1 Preliminary data**

maxillary bone and abnormal teeth occlusion (**Figure 2**) [17].

reconstructions extremely helpful in planning surgery [18].

importance and eases communication between clinicians [19].

and ideally visualizing pretreatment 3D reconstructions [20].

**2.3 Classification of midfacial fractures given the impact energy**

**3. Principles of treatment in craniofacial multiple trauma cases**

**2.2 Classification of fractures of the middle facial vault according** 

bleeding, subcutaneous emphysema, and infraorbital grove numbness. The oral cavity exam shows swelling of the superior vestibule, dental occlusion difficulties in vertical and sagittal planes, maxillary depression, and lack of lateral teeth superposition [15]. High-level transverse fracture LeFort type III has a violent mechanism of production at the level of the glabella or from lateral. The trajectory of such a fracture passes through the vomer, upper third of the nasal bones, ascending arch of the maxillary, ethmoid bone, floor of the orbit, external orbital wall, upper third of the

*Fracture LeFort type III—CT scan with 3D reconstruction, clinical aspect before surgery, and surgical* 

At physical examination, the case presents depression of the nasal vault, tumefaction around both orbits, blood in the anterior eye pole, nasal bleeding, double vision, and facial subcutaneous emphysema. The oral cavity exam shows an abnormal movement in vertical and transverse planes of the mandible with retrognate

An emergency CT scan is compulsory in both axial and coronal planes with 3D

There are nasal fractures, combined nasal-orbital-ethmoid fractures, and complex maxillary-orbital-zygomatic fractures. This classification has a clinical

From this point of view, we encounter fractures with high energy and low energy. So, the diagnosis should include the landmarks in the midface affected according to the clinical exam, along with the information provided by the CT scan

First, we have to secure the airway. Then, control nasal bleeding and other hemorrhages at the level of head and neck (**Figure 3**). Exclude any lesion at the level of the cervical spine. Also, check for any other occult life-threatening lesions such as spleen ruptures. This implies a second top-to-toe complete evaluation in 48 hours from the admission time and before any surgical interventions at the level

**88**

*CT scan performed for a nasal vault concussion without fracture of the nasal bones but with a fracture at the level of the ethmoid perpendicular plate associated with CSF leak (accidental fall on the stairs).*

of the head and neck along with a complete inventory of all the lesions presented by the patient. Moreover, question the patient if possible or the relatives about prior associated pathology which could have an essential role in the prognosis and treatment outcome [21].
