Facial fracture classification according to skeletal support mechanisms.

OBJECTIVE To construct, propose, and evaluate the usefulness of a new clinical facial fracture classification scheme to accurately denote, communicate, and compare facial fractures. DESIGN A retrospective, consecutive sample study with application of the proposed classification scheme to denote maxillary and zygomatic fractures with computed tomography. SETTING Metropolitan tertiary care trauma center. PATIENTS A total of 213 consecutive adult patients with facial fractures evaluated by means of 2-dimensional computed tomography. RESULTS The classification scheme is defined according to fractures of vertical buttresses and horizontal beams. The scheme uses 3 primary descriptors of laterality and support sites to denote the clinical pattern of the fractures. This scheme was accurately applied and sufficient to describe 87 midfacial fracture patterns in this study. In addition, 118 (98%) of 120 mock fracture patterns were correctly transcribed and reproducibly communicated among 12 participating physicians. CONCLUSIONS This newly proposed facial fracture classification scheme provides a convenient, specific, descriptive, and reproducible method of denoting fracture patterns. This scheme may be used to accurately communicate and compare, in greater detail than permitted using current independent classification schemes, the essential site and degree-of-severity characteristics of facial fractures critical to their surgical reduction and reconstruction. The usefulness of this classification scheme in determining optimal methods and subsequent outcomes in midfacial fracture reduction requires further investigation.