Facial trauma, also known as maxillofacial trauma, can be a very complex injury. Usually, it requires special attention from a qualified oral surgeon. It’s almost never something you want to treat at home with an ice pack. In addition, maxillofacial patients usually face long treatment times.
We’ve put this page together to help you gain a better understanding of facial trauma, including what it is and how it is treated. We want to prevent you from making major mistakes which could cause problems for you in the future.
Maxillofacial trauma is any physical trauma to the face. This can include:
The most common sport and vehicle-related trauma to the mouth and jaws are dentoalveolar/tooth injuries and lower jaw fractures. A less common type is called a Le Fort injury (upper jaw fracture). Cheekbone fractures, known as zygoma, or orbital fractures, may also occur.
We also see patients with dentoalveolar injuries. This very long word refers both to the teeth and to the bone that supports the teeth. A sudden, direct blow to the mouth is the most common cause of injury. At times, these patients also experience numbness.
The most common causes of facial injuries are:
Injuries can also include soft tissue injuries. This includes injury to the skin and gums or injuries to bones. It can also include palate fractures, cheekbone fractures, eye socket injuries and damage to sensitive regions such as the eyes, ears, and facial nerves.
Any of these injuries can lead to permanent facial disfigurement. This means if you don’t seek proper treatment you can lose facial function. Since our faces are usually the first thing people see about you this can lead to a loss of self-esteem, impacting your ability to form meaningful relationships or pursue a career.
Check for symmetry in facial features. You should also inspect for bruises, swelling, and lacerations. Check the nose for signs of dislocation or for telecanthus, which is the widening and flattening of the nasal bridge. You should also check the mouth region for avulsed teeth, mobile teeth, or jaw malocclusion.
This type of injury is usually treated in stages.
First, we stabilize the fractured segments and teeth with small titanium plates and screws. We also wire the mobile teeth to an arch bar.
Stage two usually consists of placing bone grafts into defects and rebuilding the site in preparation for dental implants and, eventually, new teeth. The bone grafts may be taken either from other sites in the jawbones or a human cadaver bone.
Bone grafts usually take four to six months to heal.
To understand maxillary fractures and their treatment you first need to understand that these regions are split into three parts: the upper maxilla, mid-maxilla, and lower maxilla. Depending on the severity and cause of the facial trauma there are three classifications for these features.
Le Fort 1 – A horizontal fracture across the inferior aspect of the Maxilla, often extending through the lower nasal septum. This may be the result of a direct blow on the maxillary rim in a downward direction.
Le Fort 2 – A pyramid-shaped fracture caused by a blow to the lower or mid maxilla, which extends from the nasal bridge through the frontal maxilla. This may cause facial swelling, epistaxis, and a sub-conjuctival hemorrhage.
Le Fort 3 – A transverse fracture, also known as craniofacial disjunction, which is the result of a blow to the nasal bridge or upper maxilla, and causes separation of the facial bones from the cranial base.
One of the top concerns related to this facial trauma is the possibility of closed airways. generally, there is an immediate need to ensure that air passages are open. Any facial features that threaten airways will be moved back into place, which both opens airways and reduces bleeding. Treatment goals include repairing the bone’s natural bone architecture in order to avoid leaving any signs of the injury.
We can treat soft tissue with surgical sutures. We treat bone fractures based upon the location of the fracture, the extent of the fracture and the general health of the patient. Since it is not possible to stabilize facial fractures with casts we’ll use wires, plates, and/or screws instead.
The patient may also have to wear dental braces. We try to retain as much of the patient’s facial appearance as possible.
Finally, using advanced techniques we can now use microplates and resorbable plates to treat facial fractures. Injuries to the teeth may require the teamwork of several dental specialists, depending on the injury.
Lower jaw fractures are very common. Usually, they are the result of a direct blow to the chin, or to the body of the lower jaw. The most common symptoms are pain, swelling, a numbness in the lower lip and an inability to fit your teeth together. There are two primary ways to fix this.
The first is immobilization–we wire the jaws together to let them heal. The second is called an open reduction, and it involves placing titanium plates and screws inside the jaw.
Either way, the healing process usually takes between four and six weeks.
These injuries usually happen after personal altercations or fights, when the patient suffers from a direct blow with a fist or object. The symptoms include a “flat” cheek appearance, numbness in the midface region, difficulty chewing and a limited range of motion which makes it hard to open your mouth.
Treatment usually consists of re-positioning the Zygoma from multiple incisions, then placing plates and screws. Healing time takes four to six weeks.
Oral and Maxillofacial surgeons have highly specialized training which prepares them to handle the fractures and damage described above. Most residency programs add four to six years of additional hospital-based training beyond dental school. Oral and maxillofacial surgeons typically have more training and experience with maxillofacial trauma compared to other surgical specialists.
Our doctors routinely deals with facial traumas. Most of his four-year hospital based surgical residency was focused on maxillofacial surgery. In addition to his experience working in hospitals and my own practice with patient traumas, he continues his education and keeps up with the latest procedures. This allows him to provide his patients with the most advanced care possible when dealing with these serious injuries.
