Facial Trauma

What is facial trauma?

Facial trauma also known as maxillofacial trauma is any injury to the face or the jaw bone. Patients that sustain facial trauma may have breaks in their skin or “lacerations” and fracture to the upper and lower jawbone and broken teeth. It is also possible to have damage to the bony socket known as the “orbital socket” around the eye and in the case of a broken nose there may be blockage or “obstruction” of the nasal cavities or sinuses.

How does facial trauma occur?

The most frequent causes of facial trauma include sports injuries, motor vehicle accidents, work-related injuries, penetrating injuries and violence. In children under three years of age falls account for most facial trauma.

What are the symptoms of facial trauma?

• You will experience pain in the facial area.
• You may have difficulty breathing through your nose because of the swelling and bleeding in this area.
• You may experience changes in sensation or numbness in your lip, cheek, nose and tongue.
• You will have swelling around the eyes that may limit your vision.
• You may have a bad bite or “malocclusion”.
• You may have double vision.
• Some of your teeth may have been broken or knocked out or “avulsed”.
• You will have deep cuts and bruises to the face.

Where can I be treated for my injuries?

If you have an injury to your face you should seek immediate attention. You may present yourself to the emergency department of the closest hospital. You may contact your general dentist who will refer you to an oral surgeon or to a hospital emergency department. Depending on the severity of your condition, treatment may need to be done in hospital and may require an overnight stay. If the injuries are less severe, they can be attended to in the oral surgeon’s office.

What role can a maxillofacial surgeon play in treating my injuries?

Oral and maxillofacial surgeons are dedicated members of most emergency trauma teams. Because of their extensive dental and surgical training, they are uniquely qualified to optimally restore both the esthetics and function of your facial features following injury. The face allows people to recognize each other and communicate. Your surgeon is particularly sensitive to the emotional impact of an injury to your face and the importance of restoring the appearance you had prior to the trauma to give you the best possible cosmetic result.

How will my surgeon assess my injuries to determine what kind of treatment I need?

• Your surgeon will examine your injuries to determine the extent of the lacerations and whether there are fractures.
• Bruising around the eyes may be a sign of fracture of the bones around the eye sockets and the cheek bone.
• You may have sustained a fracture of your upper jaw if it moves when your head is maintained in a stable position. Abnormal sensations of the cheeks or other facial area may also be signs of fracture.

What type of treatments will I undergo?

If your surgeon determines that your injuries need to be treated by surgical procedure, his/her overall objectives are to:

• Establish a clear airway so your breathing is made easier.
• Control the bleeding.
• Treat the fracture.
• Ensure there are no other injuries.
• Keep scarring to a minimum by using the existing breaks in the skin and placing incisions in the mouth, around the eyes and scalp to expose and repair broken bones.
• Provide treatment as quickly as possible, as long as you are stable and cleared of any life-threatening injuries.

As with other broken bones, the facial bones need to be aligned in their proper position or “reduced” and maintained in this position to allow for proper healing. This is referred to as “stabilization” or “fixation.” Since a cast cannot be used for fixation in the face, other techniques are used. When a jaw fracture is uncomplicated, treatment can sometimes be done by a “closed reduction”. This involves moving the fractured portions of bone into their appropriate position and stabilizing the bone segments using devices such as splints. For jaw fractures “arch bars” which resemble braces are used. The arch bars are used to wire the patient’s jaws together for a period of 4 to 6 weeks. During this period, they receive their nutrition through a liquid diet. The non-surgical approach is less invasive and avoids the potential complications and scarring associated with surgery.

When facial fractures are more complex, surgery is often required to align the bone segments and stabilize them. Titanium plates and screws are most often used to stabilize the segments. Although more invasive, this open approach eliminates the need for wiring the jaws together for the traditional 4-6 week period. Most of the incisions used to access the jaws are made inside the mouth.

Injuries to soft tissues are repaired by stitches or “suturing”. Your surgeon will take great care to identify and repair injuries to any other structures in the area including facial nerves and the ducts and glands which carry and store saliva.

Frequently teeth are injured or knocked out in the trauma. Your oral surgeon will re-implant these displaced teeth and stabilize them by placing wires around the teeth or bonding them together, referred to as “splinting. Should you recover your knocked out tooth, place it immediately in milk or salt water and avoid wiping it as this may damage some of the supporting tissue attached to it. If you cannot get dental care or replace the tooth in the socket within 30 minutes, the chances of tooth survival is greatly reduced. If the tooth cannot be saved, dental implants are successful alternatives for tooth replacement.

What can I expect after my surgery and how long is the recovery period?

Generally when the soft tissues lacerations and bone fractures of the face are properly repaired and aligned these structures tend to heal very well. The length of time it takes for a patient to recover from a facial fracture is very variable and depends on the extent of the injury.

When a patient needs to have his or her jaws wired due to a fracture this fixation is usually maintained for an average duration of 4 to 6 weeks. The need for jaw wiring has diminished significantly due to advances in the technology and instruments used for the treatment of facial fractures.

The most significant inconvenience reported by patients who have their jaws wired is the inability to eat a normal diet as foods must be consumed in liquid or pureed form during this period.

The other reality of any major facial surgery is the side effect of facial swelling and bruising that usually disappears within 7 to 10 days after the surgical procedure. In more extensive surgeries it may take up to 6 months for the facial muscles (cheeks and lips) to fully return to a normal form and condition.

It is very important that you follow the instructions relating to wound care and nutrition that will be provided to you by our team.