Facial Trauma Management – Prompt and Effective Treatment

“War was easy. The hard part was cleaning up afterward.”

This modest quote by Evan Meekins accurately sums up the management of facial trauma. We encounter falls and fights and accidents every now and then and while we spend almost no time at all thinking about the injuries we would receive or give during the episode itself, planning the treatment of these injuries after the incident is a completely different story altogether and may prove to be a mammoth task at times.

Proper realignment of broken bones and torn soft tissues is of vital importance to restore the facial esthetics and functions (eating, swallowing, vision, smell, etc.) to pre-trauma levels. The timing, approach, method of immobilization and various other variables have to be meticulously planned to maximise optimum outcome, while minimising surgical morbidity. The general principles of facial trauma management and wound care are applied in all cases.

Injuries to the craniofacial region are very common, and may be isolated or associated with other related injuries like to the brain or the chest. The damage may be limited to superficial tissues or involve deeper structures.

Facial trauma management is an essential and sensitive surgery that requires thorough planning and prompt and effective treatment. Let’s get a thorough understanding of Facial Trauma Management in Delhi.

What is Facial Trauma?

As the term suggests, it refers to an injury to the face. Also known as maxillofacial trauma, it broadly involves soft tissue injuries as well as fractures on the face and neck region. These injuries can cause disfigurement and loss of function, for example, blindness, a deformed nose or difficulty in moving the jaw.

Depending on the type of facial injury, the treatment can include suturing of open wounds, bandaging, administration of ice, painkillers, antibiotics, setting fractures bones back into place, and surgery to repair the injured tissues.

What does Facial Trauma include?

Facial trauma can involve injury to the tissues of the head and neck region including:

• Laceration of the facial skin, tongue, and/or gums
• Burns and bruises
• Fracture of the jawbones, orbit, and/or nasal bones
• Fracture / loosening / loss of teeth
• Eye Injuries
• Injuries to the Temporomandibular Joint (TMJ)

What Causes Facial Trauma?

Facial trauma is a common occurrence in our daily lives and can be because of several reasons. The common causes include:

• Road traffic accidents
• Self-inflicted injuries
• Interpersonal violence
• Activities of daily living
• Falls
• Animal attacks
• Sports
• Recreational activities

It is important to remember that one must always be careful while doing something that could lead to a fall, accident, or any of the above and result in facial trauma from a degree of mild to severe. Once injured, it is vital to consult a maxillofacial surgeon at the earliest to prevent long-term complications.

What are the various types of Facial Fractures?

1. Broken Nose (Nasal Bones): These fractures are among the most frequent facial injuries as they affect two thin and prominent bones. Thus, it requires minimum force to injure or crack the nasal bones compared to other facial bones. If there is a fractured or broken nose, it might feel sore to touch or look deformed. There can be swelling in the region, making it difficult to determine the severity of the fracture. Bruising and nosebleeds near the nose are the most common signs of a nasal bone fracture.

2. Forehead (Frontal Bone) fractures: The forehead bone is a prominent bone on the face. A forceful injury to the head or upper face bone can cause a fracture in the forehead bone and the sinuses. This injury can cause the forehead bone to be depressed and deformed. An extreme force is needed to shatter the frontal bone, and hence, when this happens, it is common to find other injuries to the face and skull or brain. Other problems can include leakage of the cerebrospinal fluid, eye injuries, and damage to the sinuses.

3. Broken cheekbone/upper jaw (Zygomaticomaxillary fractures): The cheekbone, also known as the zygoma, is connected at many points to the maxilla or upper jaw and skull bones. Therefore, fractures in the cheekbones can also cause fractures in the adjacent facial bones. The cheekbone is vital to the facial aesthetic as it establishes the facial width and its fracture can cause cheek flattening and facial asymmetry. This bone also supports the eyeball and its fracture can destabilise the eye position.

4. Eye socket fractures (Orbital fractures): There are three types of orbital fractures:

• Orbital rim fracture: involves fracture of the thick bone forming the borders of the eyeball bony socket, which requires a lot of force to break.
• Blowout fractures: In this case, the orbital rim remains intact; however, a crack forms in the thin bone forming the floor of the eye socket. Here, the eye muscles and other structures can become entrapped in the crack and prevent normal movement of the eyeball.
• Direct orbital floor fracture: It is a rim fracture that can also cause injury in the lower socket.

5. Mid-face (upper jaw or Le Fort fractures): These fractures are a result of blunt force, and occur along three lines of weakness on the mid-face. There are three main types of mid-face fractures:

• Le Fort I: fractures the upper jaw at a level just above the upper teeth.
• Le Fort II: fractures the upper jaw at an upper level, across the bridge of the nose, obliquely on either side around the nose and under the eye.
• Le Fort III: separates the face from the skull across the bridge of the nose and the bones around the eyes.

6. Mandible (lower jaw): The lower jaw keeps the teeth on the lower jaw in place and moves when you talk or chew food. Fractures to this region can impact the area of the lower jaw that supports your teeth and the area where the jaw makes a joint with the skull. If you have a fracture in the mandible, you might have loose or broken teeth, disturbed dental relationships, lower lip numbness and possible facial asymmetry.

How do I know If I have Facial Trauma?

If you have suffered an injury to the face in the recent past and have had any of the following symptoms, you should consult an oral and maxillofacial surgeon at the earliest.

In a nose fracture, you might experience purplish patches on the skin over the nose and around the eyes due to blood leaks from the broken blood vessels. The nose may appear deformed and crooked and nose bleeds may be seen.

Orbital fractures can cause blurry or double vision along with difficulty in moving eyes left, right up, or down. You may also find swelling under the eyes and swollen forehead or cheek. Other symptoms can include sunken or bulging eyeballs, flat cheeks, and facial numbness with discoloration in the white part of the eye.

In lower and upper jaw fractures, you might notice trouble in chewing, eating, or speaking, along with loose, broken, or missing teeth. Usually, such injuries are accompanied by cheek pain while opening the mouth.

Other symptoms:

• Asymmetry of the face
• Inability to open the mouth completely
• Bleeding from the nose/mouth
• Teeth not meeting properly
• Difficulty in chewing
• Excessive bruising around the eyes
• Numbness in the lower lip region

Do I need surgery for the treatment of Facial Fractures?

Many facial fractures can be treated without surgery; by using conservative fracture reduction techniques. You must consult a maxillofacial surgeon to determine if this is the right treatment for your injuries.

As facial bones are constantly under chewing and talking loads, most facial fractures need to be properly realigned surgically and fixed rigidly with small titanium plates and screws. Proper fixation of the fractured bone segments allows an early mobilization of your bones and reduces the recovery period as compared to non-surgical methods of treatment.

What is the procedure for treating Facial Fractures?

The usual treatment for facial fractures involves two main steps:

• Fracture reduction or ‘setting the bone’ and
• Fracture fixation or holding the bone in its aligned correct position

Facial fractures can be treated by setting the fractured facial bones (reduction) manually in their original place and keeping them in the proper position (immobilization) for a particular period of time, allowing bones to heal.

Surgical reduction and fixation of fractures yields a more accurate outcome than non-surgical techniques and allows an early return to normal function. These surgeries are usually performed from inside the mouth and leave no scars on the face.

How long do Facial Fractures take to heal?

The time it takes for a facial fracture to heal depends on the type and severity of the injury. Initial healing of most facial fractures takes around 4 – 6 weeks. As jawbones bear the weight of chewing forces, a good resting period is required to allow for the bones to heal before resuming normal function.

Recovery after Surgical Treatment of Facial Fractures?

Most facial fractures need good after-care post-surgery in terms of diet and wound hygiene. Here are some points about recovery after the surgical treatment:

• Some facial swelling may be seen for up to 2 weeks after surgery
• Sutures placed inside the mouth will need regular rinsing for wound hygiene
• Diet will need to be kept soft / semi-solid for up to 4 weeks
• Temporary numbness of the lip may be felt for up to 6-8 weeks after surgery
• A period of jaw closure may be required for 7-10 days

What happens if you leave Facial Fractures untreated?

When facial bones are fractured, it is of utmost importance to get them properly treated in time.

Usually, bones are exceptionally good at healing and fractures have the potential to make a full recovery when treated timely and properly, resulting in a bone that is as good as new. However, if left untreated, the problem can worsen and lead to complications and more pain and suffering.

Untreated facial fractures may lead to:

• Facial contour deformity
• Inability to bite
• Reduced chewing efficiency
• Jaw joint (TMJ) pain
• Change in the appearance of the eyes, nose, and/or smile
• Diminished nerve function and sensations

Results of Facial Trauma Treatment

After the treatment for facial trauma, depending on the type of injury, patients will have repaired lacerated tissues and esthetic facial scars. Along with that, any displaced bone fragments will be aligned back into their original position, and facial deformities will be corrected. Disturbed jaw and dental relationships will be corrected, resulting in improved chewing efficiency and preventing future TMJ problems.

Contact Dr. Sanchaita Kohli for further details

It is unfortunate to suffer from facial trauma due to the causes discussed above. However, if you have recently had facial trauma, do not worry about the treatment, as we are here to guide you and give you the best treatment.

We understand that you might be physically and emotionally traumatized, and proper treatment becomes very important when dispensing on the severity of the trauma. We have covered all the necessary information that you might need about facial trauma management. However, having further questions is only natural.

For facial trauma, consult Dr. Sanchaita Kohli, a reputed Maxillofacial Surgeon, trained with international standards in Facial Trauma Management (AOCMF). Dr. Sanchaita Kohli operates at the prestigious cosmetic surgery setup of RG Aesthetics and is certified in Advanced Trauma Life Support (ATLS) by the American College of Surgeons.