PROTOCOLS FOR THE DIAGNOSIS OF FACIAL FRACTURES

Abstract

Maxillofacial trauma is a very common injury, accounting for approximately 30% of emergency department admissions, which requires rapid and interdisciplinary diagnostic protocols without compromising accuracy. Ghanaati (2022) discusses how a systematic approach in the initial examination can prevent wasted time with unnecessary diagnostic tools, optimizing the flow of care. It is fundamental that the protocol prioritizes the patient's systemic stabilization before any maneuver aimed at facial injuries, as pointed out by Rittri (2024), who also emphasizes the need for a detailed examination of facial nerve function and parotid gland integrity in cases of deep lacerations or amputations. According to Boljevic (2023), in the clinical examination, signs such as dental malocclusion, paresthesia (mainly in the infraorbital nerve), facial asymmetry, and limitation of mouth opening (trismus) are considered pathognomonic indicators that should guide the initial clinical suspicion. High-resolution computed tomography (CT) is undoubtedly the gold standard in the field of imaging for a definitive diagnosis. When dealing with complicated cases of atrophic mandibles, Cienfuegos (2023) highlights that it is crucial to perform CT scans with 1 mm slices for a thorough study of cancellous bone density and mandibular height, which allows the application of the Luhr Classification (Classes I to III) as a guide to the need for bone grafts and the choice of fixation system. Regarding sports injuries, Shreya (2022) points out that, although mandibular fractures are recorded, soft tissue injuries and dental trauma, such as avulsions and enamel fractures, occur more frequently, requiring specific protocols for tooth preservation. Finally, according to the evidence cited by Boljevic (2023), diagnostic and therapeutic intervention should ideally be performed within the first two to three days after the trauma in order to avoid complications such as infections and malunions, ensuring a rapid functional return for the patient.