Symposium on maxillo‐facial trauma. IV. Pitfalls in the treatment of mid‐facial trauma

The overall treatment of severe mid‐facial trauma calls for specialized knowledge and experience in an anatomical area shared by a number of surgical specialties. Increasing specialty board requirements and changing respect for anatomical boundaries among the various specialties make the mid‐facial area a bone of contention in medical centers with a limited volume of facial trauma cases. The need to share this educational resource is recognized; however, its distribution may be considered an educational pitfall among those more clinical in nature. The following clinical examples in the treatment of mid‐facial trauma have been briefly discussed and illustrated: 1. Serious hematoma formation unrecognized or underestimated. 2. Magnitude of facial bone injury unappreciated by initial observation of the patient and review of preliminary X‐rays. 3. Poor selection of airway for delivery of general anesthesia. 4. Unnecessary use of wire suspension for facial fracture immobilization. 5. Failure to establish centric occlusion. 6. Unrecognized inter‐canthal trauma. 7. Impacted nasal fracture unreduced by closed reduction efforts and left untreated. 8. Treatment of soft tissue injuries without regard for facial skeletal injuries. 9. Vital structures discarded at time of initial treatment. 10. Failure to replace missing dental elements early to avoid contracture. The trend towards introduction of lesser trained personnal in the intial treatment phase of facial traumam, coupled with the trend towards prepaid health group care suggests that the errors of treatment are likely to persist and in all probability to increase.