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Cranio-Maxillofacial Trauma


There are multiples causes of complex facial deformity including congenital deformities, cancer resection and trauma. Road accidents, assaults and sports injuries are common causes of Cranio-Maxillofacial trauma.

Examples of some of the complex deformities that may be corrected by modern Cranio-Maxillofacial and reconstructive surgery techniques are shown below.

Panfacial fractures 1

This man crashed his four wheel drive in the Australian outback and was not found for nearly 24 hours.

He has severe fractures of the lower two thirds of the face.


Panfacial fractures 2

This man crashed his motorbike at high speed. The postoperative CT shows where I have placed plates at the nasal root, around the eye sockets, the cheek bones, zygomatic arch and mandible. The floor of the eye socket has been reformed using hip bone.

The teeth have been wired together to maintain dental occlusion.


Submental intubation

This girl sustained multiple facial fractures during an explosion. I have placed the endotracheal tube beneath the chin to avoid having a tracheostomy.

I have written a paper about my experiences with submental intubation in Australian and New Zealand Journal of Surgery.


Mandible fracture

This boy fractured his lower jaw into 4 pieces in a road crash.

Both condyles and the parasymphyseal region were plated into correct alignment.


Paediatric mandible fracture

This 5 year old boy fell out of a window fracturing his lower jaw in 2 places.

Traditional plating would destroy the buds of his adult teeth and so I repaired the fractures with superficial absorbable fixation


Condyle fracture

This young girl was assaulted fracturing the condyle of her mandible.

I have plated this through a submandibular Risdon incision.


Intracranial condyle penetration

This man fell over the handlebars of his bicycle and pushed the condyle of his mandible through the skull base into the cranial cavity and fractured it on the other side.

I have written a paper about this type of injury in Australian and New Zealand Journal of Surgery.

Intracranial condyle penetration

TMJ ankylosis

An old injury of the Temporomandibular joint (TMJ) has caused a fusion or ankylosis.

This is a notoriously difficult condition to treat.


Mandible gunshot

This man was shot in the lower jaw and all bone from the from angle to angle is missing.

This was reconstructed using a bone free flap from the leg and a soft tissue free flap from the arm.


Maxillary occlusal fracture

This man was running from the scene of a crime when he tripped and sustained this injury.

I aligned his upper teeth and used hip bone to replace the missing maxillary bone.


Dental Models

Dental models together with occlusal wafers are used for complicated segmental fractures involving dental segments.


Palatal fracture

This young man was a driver in a high speed boat accident. Accurate fracture reduction was critical to achieving the correct bite


Simple zygomatic arch fracture

This simple arch fracture can be elevated using a Gillies lift if the periosteum surrounding the fracture is intact.


Gillies lift

An elevator is passed beneath the deep temporal fascia and under the zygomatic arch then gently elevated.

This is a case I performed in a young man hit with a cricket ball.


Zygoma fracture

Although this zygoma fracture could be elevated with a Gillies lift it would not stay in position and I have placed plates through the mouth to maintain the reduction.


Comminuted zygoma fracture

In this more extensive zygoma fracture, the root of the zygomatic arch has fractured off in front of the ear. It is part of a Le Fort III complex fracture. If not corrected, the face will remain flat and wide.

I plated this using a coronal incision over the top of the scalp in the hair. Note the fractured nasal septum.


Fractured nose

A fractured nose heals quickly and is best manipulated into position within the first two weeks after injury.


Old fractured nose

This is a preoperative view of an old fractured nose that has been incompletely reduced.

The bones must be refractured and the nasal septum straightened.


Naso-orbito ethmoid fracture

This young girl has an untreated NOE complex fracture. As a result she has a depressed “saddle nose” and telecanthus.

The attachment of the medial canthal tendon must be reattached to the side of the nose to resuspend the eyelids.


Costochondral graft nose

This man has a saddle nose deformity following a naso-orbital ethmoid fracture.

I have harvested a costochondral graft from the ribs and am about to place this via an intranasal incision.


Retrobulbar haematoma

This elderly lady fell at home bleeding into the soft tissues behind her eye. Note how much further forward the globe is on this side.

Surgery is sometimes required to temporarily relieve the pressure on the globe and subsequent blindness.


Orbital floor blowout

This man was assaulted and the contents of his orbit have “blown out” into the maxillary sinus.

This must be corrected to prevent double vision and a sunken eye (enopthalmos).


Orbital floor bone graft

I am placing a bone graft from the hip to reconstruct the floor of an eye socket that has been fractured.

Hip bone is easy to contour into the desired shape.


Medial orbital wall bone graft

This man has a fracture of the medial orbital wall in a road accident which tethered the medial rectus muscle which moves the globe.

I have placed a hip bone graft across the fracture site.


Optic nerve transection

This man had a foreign body enter his neck and pass through his eye socket in a work place accident.

The eye socket has been fractured inwards and the bone has cut the optic nerve making him blind.


Lateral orbital wall fracture

I repaired this lateral orbital wall fracture using a combined temporal and upper blepharoplasty incision


Depressed skull fracture

This young tourist had a depressed skull fracture sustained during a bomb blast in a terrorist attack on a night club. He had 25% burns and shrapnel injury.

I have repaired his naso-ethmoid complex fractures and elevated the skull fractures with a neurosurgeon. Pericranial flaps were used to repair dural tears.


Frontal sinus fracture

A craniofacial approach has been used to repair this fracture of the frontal sinus.

The posterior wall was removed and all the frontal sinus space turned into part of the cranial cavity.


Tension pneumocephalus

This is a possible complication of frontal sinus fractures.

Air in the nose under high pressure is forced into the cranial cavity but cannot escape and the brain becomes increasingly compressed



Another complication of untreated frontal sinus fracture when the sinus cannot drain properly.

Mucous produced in the sinus forces its way out into the forehead soft tissue but can also go into the orbit or the cranial cavity.


Lacrimal mucocoele

This mucocoele formed when the tear drainage of the lacrimal sac was interrupted by a maxillary fracture.

An alternative tear drainage into the nasal cavity was created.


Decompressive craniotomy

This young girl in a road accident had severe intracranial swelling caused by blunt cranial trauma.

The front part of her skull was removed to prevent high pressure on the brain tissue causing death. Her skull was kept in a freezer and then replaced three months later.

• Craniofacial Surgery
 · Craniofacial Anomalies
Complex Craniofacial Deformity
Craniofacial Trauma

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