Anatomy

The facial buttresses, bony arches joined by suture lines, provide vertical and horizontal support. Vertical stability depends on the zygomatic-maxillary buttress laterally and the frontal process of the maxilla medially. The zygomatic-maxillary arch and the hard palate bolster the horizontal face. Sutures linking these facial bones rupture in predictable fashion during trauma. Knowledge of their location enables one to palpate these sutures to detect diastasis or tenderness.

Sutures found at borders of the sphenoid wings, pterygoid plate, and the zygomatic arch anchor the face to the skull. These are the structures disrupted in LeFort injuries (Fig 2.4..9:!).

FIG. 249-1. Coronal and lateral facial bone anatomy. (Reprinted with permission from Isenhour J, Colucciello S: Maxillofacial trauma, in Ferrera P et al: Trauma Management. St. Louis, Mosby, 2000.)

The most complex aspect of facial anatomy is the orbit, an elaborate structure comprised of seven different bones: maxilla, zygoma, frontal, sphenoid, palatine, ethmoid, and lacrimal. Between these bones lie the orbital foramina, through which course cranial nerves II, III, and VI and branches of V. Rupture of orbital bones may compress these fissures and cause blindness through traction, rupture, or compression of the optic nerves.

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