Facial injuries are common in motor vehicle accidents because most people are protected by restraints from the shoulders down and their faces lead, especially in front end collisions. The person can get facial contusions, facial lacerations and facial fractures, especially of the mandible, maxilla and nasal bones. Such facial injuries can lead to a great deal of destruction of vital structures, including the nose and the eyes. The eyes can be subject to blowout fractures, in which the eye sinks into the maxillary sinus with fractures of the orbital bones and the maxilla. Vision can be severely impaired and the inferior muscles can become entrapped in the fractured area of the maxillary sinus.
The common symptoms of facial fractures are lacerations and bruising at the site of the fracture. There can be malocclusion of the bite, especially with mandibular and maxillary fractures. There can be an obvious deformity with sinking in of the maxillary sinus, abnormally appearing eyes and sinking in at the level of the zygomatic arch. There can be bleeding from the nose and mouth as well as from any lacerations sustained.
One study looked at facial fractures, particularly of the midface to see what kinds of injuries were sustained. They noted that midface fractures were often accompanied by injuries to the eyes. Some people actually went blind as a result of this type of injury and did not recover their eyesight. Others lost their eye altogether in what could be described as a traumatic enucleation.
The researchers looked at eleven articles that met the criteria for the study. A total of 14,535 patients were studied with an average of 1211 patients in each study. The rate of vision loss in all of the studies averaged 1.7 percent. Most injuries that resulted in loss of eyesight were orbital blow out fractures and periorbital fractures. Blindness was also noted frequently in those who sustained zygomatic arch fractures at a high impact. The zygomatic arch is located just to the lateral aspect of the eye and is a relatively delicate part of the facial area. The arch is fractured whenever the person’s face is struck on the side as in a side impact collision or a front end collision with the patient’s face turned to the side. Even though these are delicate areas of the face, it still takes a great deal of impact force to break this area.
Other fractures to pay attention to are maxillary bone fractures, which includes the maxillary sinuses. The maxillary sinuses are rather large sinuses located in the cheek bones. They can be fractured secondary to a motor vehicle accident in which the person strikes the steering wheel, the dashboard or the back of the front seat. The sinus can actually sink inward, deforming the face and necessitating surgery to repair the depressed area of the face and sinuses.
In most cases, with the exception of nondisplaced fractures and nasal bone fractures, surgery is necessary to put together the fragmented pieces of the face and to begin the healing process.