3 The main objective of the vertical buttresses is to dissipate forces and transmit them along a vertically oriented vector. the structures that support the facial projection are the frontal bone, zygomatic arch and zygoma complex, maxillary alveolus, palate, and basal segment of the mandible from one angle to the other. These are the nasomaxillary, zygomatic, and pterygomaxillary buttresses 2 ( Fig. There are three vertical buttresses of the midface that provide the primary support in the vertical and anteroposterior (AP) directions. In addition, the attachments between the maxilla, zygoma, and cranium are through sutures that can readily separate. The weaknesses in the facial skeleton include the lack of complete incongruity between the base of the facial skeleton and cranium and the presence of numerous air-filled sinuses and passages with thin membranous walls. Their function is the transmission of forces to the cranium. The strengths include the maxillofacial buttresses, which are important in the structural support of the facial skeletal complex. There are a number of inherent structural strengths and weaknesses in the facial skeleton. In addition, focusing on certain anatomic landmarks will facilitate radiographic evaluation. In the presence of trauma, there will be alteration of the normal anatomy and symmetry therefore, a basic understanding and knowledge of the osseous structures of the maxillofacial region and of the basic biomechanical strengths and weaknesses of the facial skeleton are necessary. Maxillofacial Skeleton and Significance of Osseous Structures This chapter will review the role of diagnostic imaging in the evaluation of the patient with maxillofacial trauma, radiographic maxillofacial anatomy, and various imaging techniques. Although standard radiographs are still useful for assessing these injuries and their repair, especially during the intraoperative and early postoperative periods, computed tomography (CT) is widely and routinely used as initial or supplemental diagnostic imaging of facial trauma. Until the 1980s, diagnostic imaging of facial injuries consisted almost exclusively of standard facial and panoramic radiographs and, if available, tomographic studies. Although the basic treatment principles for the management of maxillofacial trauma remains unchanged, there have been significant advances in diagnostic techniques, thus improving postoperative clinical results and patient comfort and reducing morbidity. Knowledge of the bony and soft tissue anatomy of the craniofacial region and proper clinical and radiographic evaluation are paramount. One must also always maintain a high index of suspicion based on the mechanism of injury.Īccurate diagnosis is essential for the proper treatment of facial injuries and minimizing postoperative morbidity for the patient. Therefore, the treating clinical team must constantly be aware of the overall stability of the trauma patient and quickly diagnose and treat any threatening conditions. Although facial trauma alone is rarely life-threatening, associated injuries can be devastating to the precarious patient if not diagnosed early. Of all trauma patients, 25% sustain a facial injury. Maxillofacial trauma is becoming an increasingly prevalent part of the multiple trauma victim and can be extremely complex in nature.
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