<P> Commonly injured facial bones include the nasal bone (the nose), the maxilla (the bone that forms the upper jaw), and the mandible (the lower jaw). The mandible may be fractured at its symphysis, body, angle, ramus, and condoyle . The zygoma (cheekbone) and the frontal bone (forehead) are other sites for fractures . Fractures may also occur in the bones of the palate and those that come together to form the orbit of the eye . </P> <P> At the beginning of the 20th century, René Le Fort mapped typical locations for facial fractures; these are now known as Le Fort I, II, and III fractures (right). Le Fort I fractures, also called Guérin or horizontal maxillary fractures, involve the maxilla, separating it from the palate . Le Fort II fractures, also called pyramidal fractures of the maxilla, cross the nasal bones and the orbital rim . Le Fort III fractures, also called craniofacial disjunction and transverse facial fractures, cross the front of the maxilla and involve the lacrimal bone, the lamina papyracea, and the orbital floor, and often involve the ethmoid bone, are the most serious . Le Fort fractures, which account for 10--20% of facial fractures, are often associated with other serious injuries . Le Fort made his classifications based on work with cadaver skulls, and the classification system has been criticized as imprecise and simplistic since most midface fractures involve a combination of Le Fort fractures . Although most facial fractures do not follow the patterns described by Le Fort precisely, the system is still used to categorize injuries . </P> <P> Measures to reduce facial trauma include laws enforcing seat belt use and public education to increase awareness about the importance of seat belts and motorcycle helmets . Efforts to reduce drunk driving are other preventative measures; changes to laws and their enforcement have been proposed, as well as changes to societal attitudes toward the activity . Information obtained from biomechanics studies can be used to design automobiles with a view toward preventing facial injuries . While seat belts reduce the number and severity of facial injuries that occur in crashes, airbags alone are not very effective at preventing the injuries . In sports, safety devices including helmets have been found to reduce the risk of severe facial injury . Additional attachments such as face guards may be added to sports helmets to prevent orofacial injury (injury to the mouth or face); mouth guards also used . </P> <P> An immediate need in treatment is to ensure that the airway is open and not threatened (for example by tissues or foreign objects), because airway compromisation can occur rapidly and insidiously, and is potentially deadly . Material in the mouth that threatens the airway can be removed manually or using a suction tool for that purpose, and supplemental oxygen can be provided . Facial fractures that threaten to interfere with the airway can be reduced by moving the bones back into place; this both reduces bleeding and moves the bone out of the way of the airway . Tracheal intubation (inserting a tube into the airway to assist breathing) may be difficult or impossible due to swelling . Nasal intubation, inserting an endotracheal tube through the nose, may be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube could be forced through it and into the brain . If facial injuries prevent oraotracheal or nasotracheal intubation, a surgical airway can be placed to provide an adequate airway . Although cricothyrotomy and tracheostomy can secure an airway when other methods fail, they are used only as a last resort because of potential complications and the difficulty of the procedures . </P>

Bleeding from soft tissue injuries to the face is most