Fig. 5.11  Burst trauma of the midface and the mandible after severe suicidal gun shot trauma from submental through midface. (a) Clinical situation after emergency intubation. (b) CT: extensive destruction of the central midface and loss of the lower central midface structures (arrow) including the palate

a

b

CMF may also lead to tearing off the medial or – less often – the lateral canthal ligaments. Reconstructing the osseous orbital walls and repositioning the canthal ligament insertion is of utmost importance in the primary surgical intervention. A secondary reconstruction will lead to less satisfying results (Rowe and Williams 1985; Dutton and Al Qurainy 1991; Mathog 1992; Mathog et al. 1995; Rohrbach et al. 2000).

5.8.3.3  Ethmoid

Midface traumas may be combined with skull base fractures. The cribriform plate of the ethmoid bone is most frequently affected, creating a penetrating defect between the neuroand viscerocranium. Liquor fistulas, ascending infections, persisting olfactory disturbance

and traumatic damages to the brain are possible consequences (Theissing 1996; Ernst et al. 2004).

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