A Comprehensive Review of Ultrasound-Assisted Closed Reduction of Facial Fractures

Closed reduction of facial fractures is among the most performed procedures in plastic and craniomaxillofacial surgery, yet it relies fundamentally on tactile feedback and visual assessment that provide no objective intraoperative confirmation of fracture alignment. Residual displacement may go unrecognized at the time of surgery, contributing to suboptimal functional and aesthetic outcomes and, in some cases, reoperation. Ultrasound offers a portable, radiation-free, and low-cost modality capable of generating real-time cortical bone imaging at the point of care, and its application as an intraoperative guidance tool during closed reduction has attracted growing interest across multiple facial fracture subtypes. This narrative review synthesizes the current evidence on ultrasound-assisted closed reduction of facial fractures, evaluates the technical approaches and clinical outcomes reported for nasal bone, zygomatic arch, and condylar fractures, examines the emerging role of point-of-care ultrasound in the craniomaxillofacial trauma setting, and identifies the gaps in evidence that must be addressed to establish ultrasound guidance as a standard adjunct in facial fracture surgery. The existing literature, though limited by small sample sizes and heterogeneous study designs, consistently demonstrates that intraoperative ultrasound can improve reduction quality for nasal and zygomatic arch fractures with the strongest evidence for complex fracture patterns in which palpation alone provides an unreliable endpoint. Emerging data for condylar fractures are promising. Larger prospective trials with standardized technical protocols and validated outcome measures are needed to define the indications, technique, and benefits of ultrasound guidance across the spectrum of facial fractures.