Facial Fractures in Auto Accidents

Facial trauma is perhaps the most common type of injury sustained in motor vehicle accidents. Such facial fractures are often associated with other kinds of head and neck injuries including head injuries, facial lacerations and eye injuries. A facial injury is expensive, costing $9,000 to $725,000 for each injury in terms of medical costs, emergency services costs, lost work productivity, etc.

There are a number of facial bones that can be fractured. A person can sustain a mandibular fracture, which often misaligns teeth and which heals poorly. There are frontal sinus fractures, which often pushes a dent in the sinus that represents a segment of bone that is pushed in. It can block drainage of the nose and obliterate the sinus.

Nasal fractures are extremely common, especially when alone. They can result from blunt force trauma to the steering wheel, the air bags or the back of the seat in front of you. Nasal fractures can be displaced, requiring surgery to realign the nasal septum. A more complex nasal fracture is a naso-orbital-ethmoid fracture, which is from frontal trauma to the face at high velocity. The bridge of the nose crumples and the ethmoid bone/sinuses are fractured. The inner walls of the eye sockets crumple.

Orbital fractures are basically fractures through the eye socket. The bone, especially behind the eye, is thin and can blow out with fractures also of the sides, top and bottom of the eye. A true “blow out” fracture of the eye involves a fracture of the weakest point of the eye socket so that the eye itself is blown outward. The treatment can be conservative or can mean surgery to put together the fragments of bone.

There are multiple types of cheekbone fractures, including zygoma fractures, tripod and quadripod fractures, etc. Because the cheekbone is prominent, it tends to be the site of blunt force trauma. With a cheekbone fracture, the face can look lopsided. If it causes a visual deformity to the face, surgery is an option.

Upper jaw fractures or maxillary fractures are usually named Le Fort I, Le Fort II and Le Fort III, depending on the site of the fractures in the face. The Le Fort I fracture is the least severe and the Le Fort III is the most severe. Maxillary fractures, like mandibular fractures involve the teeth so they must be repaired in order to restore the alignment of the teeth. Often, the teeth are wired together during the healing time. After this is done correctly, the bones are fixed with screws and plates.

Fortunately, facial fractures due to motor vehicle accidents are on the decrease. This is likely as a result of better automobile safety features, such as airbags. Cars, in general, are designed better so that blunt force trauma strong enough to damage the face is reduced. In one study, 167,000 or so people had one or more facial fracture with 55,000 having basilar skull fractures. A total of 197,000 individuals had nasal fractures between 1997 and 2006. Of note is a reduction in facial fractures each year of that time period. Newer car models were in use which resulted in fewer facial injuries. Because of airbags, it is now side impact crashes that are the most likely to cause facial injuries. Those with seat belts alone were more likely to have a severe facial injury when compared to air bags.

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