Facial Fractures

Overview

What is a facial fracture?

A facial fracture is a broken bone in the face. The face has a complex bone structure. The facial skeleton consists of the:

  • Frontal bone (forehead).
  • Zygomas (cheekbones).
  • Orbital bones (eye sockets).
  • Nasal bones.
  • Maxillary bones (upper jaw).
  • Mandible (lower jaw).

There are many other bones that are found deeper within the facial structure. Muscles required for chewing, swallowing and talking are attached to these bones.

Nasal fractures (broken nose) are the most common. Fractures to other facial bones can also occur. You might only have one fracture, or you might have several broken bones. Multiple fractures are more likely to occur during a motor vehicle accident or other high-impact accident. Fractures may be unilateral (occurring on one side of the face) or bilateral (occurring on both sides of the face).

Is a facial fracture a serious problem?

If you suffer from a facial injury, you should seek immediate medical attention. Some fractures are minor. However, complex fractures may cause irreversible damage and can even be life-threatening.

Located near to the bones in your face are the nerves and muscles that are responsible for sensations, expressions and eye movements. The muscles and nerves are located near to the facial bones. The face is close to the brain and central nervous system (CNS). Fractures may result in damage to cranial nerves, depending on the particular type and location of the fracture. Fractures to the orbit (eye socket) may result in problems with vision. Fractures of the nose may make it difficult for the injured person to breathe or smell. Also, fractures of the jawbones may cause breathing problems or make it difficult to chew, speak, or swallow.

What are the kinds of facial fractures?

There are several main types of facial fractures.

  • Nasal bones (broken nose): Nasal bone fractures are the most common type of facial fracture. The nasal bone is made up of two thin bones. It takes less force to break the nasal bones than other facial bones because they are thin and prominent. Usually, the nose looks deformed or feels sore to the touch after a fracture. Swelling in the area might make it more difficult to assess how much damage has occurred. Nosebleeds and bruising around the nose are common symptoms of a nasal fracture.
  • Frontal bone (forehead) fractures: The frontal bone is the main bone in the forehead area. A high-impact injury to the head can cause a fracture of the frontal bone and floor of the sinuses. The fracture is mostly likely to occur in the middle of the forehead. That’s where the bone is the thinnest and weakest. An injury may cause the bone to be indented (pushed inward). Substantial force is required to fracture the frontal bone, so often other injuries to the face and skull or neurological trauma may be present. Associated problems may include leakage of the cerebrospinal fluid, eye injuries and damage to the sinus ducts.
  • Zygomaticomaxillary fractures (broken cheekbone/upper jaw): The zygomas (cheekbones) are attached at several points to the upper jaw (maxilla) and bones of the skull. Fractures to the cheekbone(s) might also involve breaks in other facial bones nearby.
  • Orbital fractures (eye socket): There are three main types of orbital fractures.
    • Orbital rim fracture: The outer rim is the thickest part of the eye socket. It requires a lot of force to break the bone. Many other injuries may accompany an orbital rim fracture, such as damage to the optic nerve.
    • Blowout fractures: The orbital rim remains intact in this case, but a crack forms in the thin bone at the lower part of the eye socket. The eye muscles and other structures can become entrapped in the break and prevent the eyeball from moving normally.
    • Direct orbital floor fracture: This is a rim fracture that extends into the lower socket.
  • Mid-face (Le Fort fractures): Blunt force trauma tends to cause fractures along three lines of weakness in the mid-face. One characteristic of all types of Le Fort fractures is the fracture of the pterygoid processes, part of the sphenoid bone. There are three main types of Le Fort fractures, but there may be individual variations.
    • Le Fort I: The fracture extends above the upper jaw (maxilla).
    • Le Fort II: The fracture extends from the lower part of one cheek, below the eye, across the bridge of the nose, and to the lower part of the other cheek.
    • Le Fort III: The fracture extends across the bridge of the nose and the bones surrounding the eyes.
  • Mandible (lower jaw): The mandible holds the lower teeth in place and moves when you are talking or chewing. Fractures of the lower jaw affect the sections of the lower jaw that supports teeth (called the body), the part where the jaw curves upwards into the neck (the angle) or the knob-shaped joint at the top of the jaw bone (the condyle) or the point where the two sides of the lower jaw are joined (the symphysis). If you have a break in the lower jaw, you may also have broken or loose teeth.

Symptoms and Causes

What causes facial fractures?

You can break the bones in your face in many ways, including:

  • High-impact accidents, such as motor vehicle accidents.
  • Sports injuries.
  • Workplace accidents.
  • Falls.
  • Interpersonal trauma like fighting or domestic violence.

What are the symptoms of a facial fracture?

Symptoms of a fracture to the face may include pain as well as bruising, swelling or tenderness.

Symptoms of a nose fracture may include:

  • Purplish patch on skin caused when blood leaks from broken blood vessels (also called bruising or ecchymosis).
  • Discoloration under the eyes (“black eyes”).
  • Blockage of one or both nostrils or a deviated septum.
  • Twisted or crooked nose or indented bridge.
  • Nosebleed.

Symptoms of an orbital fracture may include:

  • Blurry, decreased or double vision (diplopia).
  • Difficulty in moving eyes left, right, up or down.
  • Swollen forehead or cheek or swelling under the eyes.
  • Flatness of the cheeks.
  • Sunken or bulging eyeballs.
  • Facial numbness near the injury.
  • Blood or discoloration in the white part of the eye.

Symptoms of upper or lower jaw fractures:

  • Trouble with chewing, eating, or speaking.
  • Loose, broken or missing teeth.
  • Teeth not fitting together properly.
  • Cheek pain when opening the mouth.

Diagnosis and Tests

How are facial fractures diagnosed?

First of all, medical personnel will determine whether there are any life-threatening injuries. These conditions have to be addressed immediately before a more thorough examination of the face is performed. A physician will check to see if there is anything blocking the airways or nasal passages, assess pupil size and reactions, and look for any damage to the central nervous system.

The doctor will then ask questions about how and when the injury occurred. The patient or caregiver should provide information about whether the patient has any other medical problems or previous problems, such as past facial injuries or surgery. A physical exam will be performed to check the face for signs of asymmetry (one side appears different from the other) and damage to motor functions (movement). The doctor will look at the face from several angles and examine the bones of the face by palpating (gently pressing on) them.

Signs of orbital fractures may include differences in the position of the eyeballs or sunken eyes. If the measured distance between the eyes is greater than normal, it may indicate a nasoethmoid fracture. Two-dimensional face CT scans and 3-dimensional reconstructive scans may be required for diagnosis and after surgery to confirm correction of the fracture.

Your provider might order a series of plain X-rays if the nose is broken. However, you might not need X-rays if:

  • The tenderness and swelling are confined to the bony bridge of the nose.
  • You can breathe through each nostril.
  • Your nose is straight, and no blood clot is found at the septum. The septum is the piece of cartilage in the middle of the nose that divides the nostrils.

If a fracture is suspected, your healthcare provider may order a computer tomography scan (CT scan) to determine the exact location and type of the fracture or fractures. A basic series of X-rays may be sufficient in some cases to assess the fracture if a CT scan can’t be performed or if there’s no indication of a midface or maxillary fracture.

In cases where there are complex fractures of the midface (LeFort fractures), your provider might order two-dimensional face CT scans and three-dimensional reconstructive scans. These images may be needed for a correct diagnosis or before facial reconstructive surgery to improve the outcome.

Management and Treatment

How are facial fractures treated?

Your healthcare provider may prescribe pain-relieving drugs as well as oral steroids to ease swelling. Your provider will prescribe antibiotics if there’s a high risk of infection.

In general, fractures may be treated by performing a closed reduction (resetting the broken bone or bones without surgery) or an open reduction (surgery that requires an incision to reposition the fractured bones). For a complex fracture with multiple broken bones, you will need reconstructive surgery.

The type of treatment will depend on the location and extent of the injury. The aim of treatment for facial fractures is to restore the normal appearance and function of the injured areas.

Life-threatening conditions, such as blockage of the airways, cardiovascular problems, or brain or nervous system injuries, must be treated immediately.

Prevention

How can facial fractures be prevented?

There’s no way to completely prevent facial fractures. However, you can take some steps to reduce the extent of injuries.

  • Wear a seat belt when driving a motor vehicle or riding in one. Wear a helmet and other protective gear if you are operating a motorcycle or all-terrain vehicle.
  • Wear the correct protective equipment, such as a helmet and/or a face mask, when playing sports.
  • Follow safety guidelines at work and wear protective head gear if your job requires it.

You should get medical help right away if you have any of the following:

  • Open wounds where you can see the bone.
  • Bloody or clear fluid discharge from your nose.
  • Blurred or double vision, or problems moving your eyes.
  • Trouble swallowing or breathing.
  • Displaced jaw or nose.
  • Upper and lower jaw that don't meet properly, or pain when you move your jaw.
  • Loose teeth.
  • Pain and swelling in the face.

A note from Cleveland Clinic

If you think you’ve broken any bone in your face, it’s important to contact your healthcare provider. You might only need to rest and be careful about what you eat, but if the breaks are serious, they can cause problems over the long term. Luckily, facial fractures can be treated.

Last reviewed by a Cleveland Clinic medical professional on 09/21/2020.

References

  • American Journal of Roentgenology May 2005, Vol. 184, No. 5 Accessed 9/17/2020.How to Simplify the CT Diagnosis of Le Fort Fractures (http://www.ajronline.org/doi/full/10.2214/ajr.184.5.01841700)
  • Oral and Maxillofacial Surgery Clinics, 2013-11-01 Vol. 25, Iss. 4. . Accessed 9/17/2020.Management of Fractures of the Zygomaticomaxillary Complex (https://www.clinicalkey.com/#!/content/journal/1-s2.0-S1042369913001076)
  • Oral and Maxillofacial Surgery Clinics, 2013-11-01, Vol.25, Iss. 4. . Accessed 9/17/2020.Management of Fractures of the Mandibular Body and Symphysis (https://www.clinicalkey.com/#!/content/journal/1-s2.0-S1042369913000988)
  • Emergency Medicine Clinics of North America 2013-05-01 Vol. 31, Iss. 2. . Accessed 9/17/2020.Management of Facial Fractures (https://www.clinicalkey.com/#!/content/journal/1-s2.0-S0733862713000023)
  • American Academy of Ophthalmology. Accessed 9/17/2020.Orbital Floor Fractures, (http://www.aao.org/bcscsnippetdetail.aspx?id=415cdb9b-3308-4f90-bc33-dac1ebd676ce)

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