There are many causes to facial fractures, which can include motor vehicle accidents, interpersonal trauma, accidents, or work-related or sports-related activities. Patients are often seen in the emergency room for initial evaluation. In the early management period, life-threatening issues are addressed first and facial fracture repairs are only attempted after a patient is stabilized.
Almost all patients receive a fine cut computed tomography (CT) scan to evaluate the skeletal trauma. Sometimes a panorex or dental x-ray is obtained if a jaw fracture is suspected.
Orbital fractures can be isolated or occur with more extensive facial injury. These fractures are often a result of direct trauma from the front such as trauma from a fist or a ball.
Common symptoms include the following:
1. Swelling and bruising around the eye
2. Visual blurriness or seeing double
3. Numbness of the cheek just below the affected eye
4. Sunken appearance to the eyeball
Not all orbital fractures need surgical intervention. Your surgeon is more likely to recommend surgery if 1) your vision is compromised or 2) the eyeball has sagged into the socket causing a sunken appearance (which may not be obvious initially because of swelling).
Repairs usually take place approximately 1-2 weeks after the injury because swelling will have reduced by then. Incisions vary but can be placed just inside the eyelid to be hidden. The fracture is reduced, or shifted back into its normal position as best as possible, and the broken bones are often supported with a titanium plate or other similar material.
Nasoethmoid complex fractures
As with other facial fractures, nasoethmoid complex fractures, or fractures of the sinus bones in between the eyes, can occur with other facial injuries. These fractures are usually the result of high velocity trauma.
Common symptoms include:
1. Severe orbital swelling
2. Bruising around the eyes
3. Appearance of widening around the eyes
Due to the proximity of the ethmoid sinuses to the skull base, sometimes patients can have leakage of cerebral spinal fluid (CSF), or the fluid that bathes the brain and spinal cord, with these injuries. If that is the case, often a neurosurgical consultation is needed.
Surgical repair is conducted to re-approximate the proper distance between the eyes. This can involve plating and wiring of the fractured bones.
Maxillary fractures are fractures that involve the mid-face. They are usually the result of high-speed trauma, i.e. motor vehicle accidents.
Common symptoms include:
1. Change in dental occlusion or teeth not fitting together properly
2. Visual problems
3. Clear watery fluid draining from the nose
The goal of surgery for maxillary fractures is to restore the normal contour of the facial skeleton and to ensure that a patient’s jaw or bite functions as normally as possible. Many techniques can be used to access the fractures and may include incisions through the mouth or gums or in more extensive fractures, incisions in the hairline. Once fractured bones are moved back into place and stabilized, plates and screws can be utilized to keep the bones from moving again.
Mandible, or jawbone, fractures are the second most common fracture in facial trauma (the most common being broken noses). Often times the jaw is fractured in not just one but two places.
Common symptoms include:
1. Jaw pain and tenderness
2. Inability to bring teeth together properly
3. Bruising underneath the tongue
4. Numbness of the chin
The ideal time to repair jaw fractures is 7-10 days after the injury. Sometimes your doctor will prescribe antibiotics for you to take prior to surgery if the fracture extends to inside of the mouth.
Treatment options depend of the individual and the extent of the fracture. The goal of surgery is to re-approximate the teeth to the pre-injury position. This may involve maxillomandibular fixation (MMF), which fixes the upper teeth to the lower teeth for an extended period of time while the fracture heals. Patients must maintain a diet of liquids only during this time. Other options include open rigid fixation, which involves stabilizing the fracture with titanium plates and screws. The incisions can be made either through the mouth or hidden in a jaw or neck crease.
After surgery, your doctor will likely place you on an antibiotic and/or an oral rinse. You will also need to maintain a soft diet while the fracture heals.
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