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3 Head and Neck

sinus; nasofrontal injuries involve the or-bits, orbital apices, and ethmoidal roof; andcentral smash injuries involve the orbits,maxilla, and mandible. CT shows extensivefacial bone comminution, often with pos-terior fragment displacement. Nonosseousstructures that can be injured include uppercranial nerves, globes, extraocular muscles,nasolacrimal ducts, and sinuses (Fig. 3.7).

◆Midface Smash Injury

Midface smash injury is a general term ap-plied to severely comminuted, high-energyimpact, facial fractures that are not easilycategorized as Le Fort, SMC, or NOE frac-tures. They can be loosely classified based on the their location as frontal, nasofron-tal, or central, but these categories typicallyoverlap. Frontal midface smash injuries arecharacterized by disruption of the frontal

Fig. 3.7a–fa,b Frontal type midface smash. Severely comminuted fracture, predominantly involving the frontal si-nus, but with associated comminutions of the orbital walls and maxillae.

c,d Nasofrontal type. Comminuted fractures of the nasal bones, orbital roofs, orbital oors, and frontal bone. Bilateral superior orbital extraconal hematomas. Extensive soft tissue emphysema.

e,f Central smash injury. Nasal, maxillary, and lateral orbital wall fractures.