One of the most demanding aspects of emergency practice is the management of the patient who has suffered facial trauma. Whenever a maxillofacial injury is sustained, the patient goes abruptly from a normal state to a state of tissue disruption. The abruptness of the injury can cause intense emotional distress even when only minor injuries are present. When an injury is located on or around the face, the perception by the patient or family and their reaction to the trauma can seem out of proportion to the actual degree of injury.

The goal of this article is to assist the emergency physician in the diagnosis and initial management of patients who have sustained traumatic facial injuries; there is no attempt to discuss surgical treatment of fractures. Clinicians participating in the initial assessment and management of these patients require a sound understanding of the various types of facial fractures and the principles involved in their initial evaluation and treatment, however. (Injuries to the facial soft tissues or the dental structures are covered elsewhere in this issue.) The authors' intent is to provide the basic fundamentals required to assess the patient with fractures of the facial skeleton confidently and to make an appropriate referral.

The outline of the article is perhaps not in keeping with the way patients present. The authors have divided the fractures into discrete locations that are common in clinical practice. When a patient with severe facial fractures presents to the emergency department (ED) however, he or she can present a constellation of findings that encompass signs and symptoms involving all regions of the face. The initial assessment must include components for all facial fractures.