Facial fractures Referral Access Criteria
Facial fractures Referral Access Criteria
| Referrers should use this page when referring patients to public plastics and reconstructive surgery outpatient services for facial fractures. |
| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- Complex facial fracture with bleeding and/or airway obstruction that is life threatening and/or visual disturbance/threat to eye
- Acute nasal fracture with septal haematoma
- Associated neurological symptoms
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| Immediate referral |
 Immediately contact the on-call registrar or service to arrange an immediate plastics and reconstructive surgery assessment (seen within 7 days): |
- All acute facial fractures (<6 weeks) with no threat to eye or visual disturbance
- Acute nasal fractures requiring surgical intervention i.e. external bone displacement
- best results for acute nasal fracture are achieved within 2 weeks from time of injury
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| Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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- Delayed presentation (occurred ≥6 weeks ago) of orbital, nasal, or facial fractures potentially requiring surgical intervention
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| Mandatory information |
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reasons). This information is required to inform accurate and timely triage.
If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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| History |
- Relevant history, onset, duration of symptoms including injury/trauma (if relevant), and pain
- Degree of functional impairment (e.g. impact on mobility/exercise tolerance/ADLs/ability to work/quality of life)
- Details of previous treatment and outcome
- Current medication list
- Any known allergies
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| Examination |
- Cranial nerve examination (e.g. visual acuity, diplopia, pupil reaction, oculomotor)
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| Investigations |
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| Highly desirable |
| History |
- Details of smoking and/or vaping (containing nicotine) status
- Advise whether or not your patient is taking any anti-platelets or anti-coagulants
- if so, state the indication
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| Examination |
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| Investigations |
- Facial CT (axial and coronal fine slice views with bony windows)
- If mandible involved: Orthopantomogram (OPG) and PA mandible/face
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| Indicative clinical urgency category |
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Category 1
Appointment within 30 days
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- Delayed presentation facial fractures, including nasal fractures, which occurred ≥ 6 weeks potentially requiring surgical intervention
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Category 2
Appointment within 90 days
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- Long-term adverse sequelae of previous facial fracture (>12 months)
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Category 3
Appointment within 365 days
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- No defined category 3 criteria
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| Exclusions |
- Symptomatic non-acute skull fractures (headaches, neurological deficit, changes in cognition/personality/behaviour) should be directed immediately to the on-call Neurosurgery registrar or local service for immediate assessment
- Base of skull fractures
- refer to local emergency department for ENT assessment
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| Useful information |
- Acute, uncomplicated, closed facial fractures can be referred to any of the following specialties and will be triaged in line with local agreements:
- Assess for head/spinal injuries
- Contact Ophthalmology or Neurosurgery as necessary
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Last reviewed: 15-08-2025