Facial trauma has been studied by many major institutions. In one study of more than 10,000 people with facial injuries, it was found that 38 percent occurred because of activities of daily living, 31 percent were due to sports, 12 percent were related to violence and 12 percent due to traffic accidents. Five percent were due to work activities and two percent were due to miscellaneous causes.
Among the injuries were more than 7,000 facial bone fractures, 4,700 people with dentoalveolar injures and almost 6,000 people with soft tissue injuries. Males were twice as likely to sustain facial injuries as females with a mean age of 25.8 years of age.
Facial trauma is also referred to as maxillofacial trauma and represents any type of physical injury to the face. Technically, facial trauma can be any of the following injuries:
• Fractures of the facial bones
• Eye injuries
• Cold injuries–frostbite
The vast majority of facial injuries lead to pain, a loss of functionality, swelling, bleeding and deformity of the face. The face is packed with organs of function—from the eyes to the nasal cavity to the teeth and jawbone. Facial trauma rarely leads to death unless it adversely impacts the airway so the patient cannot breathe.
Facial trauma often results in a mixture of soft tissue repair and bony repair with a careful understanding of what nerves are involves as they can easily be injured in the repair, if not as a result of the trauma itself. X-rays are used to evaluate the bony structures, particularly in high velocity injuries like motor vehicle accidents.
The three main bones involved in a facial fracture include the nasal bone, the maxilla, which makes up the upper jaw and surrounding features, and the mandible or lower jaw bone. The mandible is fractured in many places, such as the body of the mandible, the angle, the ramus and the condyle or jaw joint. Other areas commonly fractured are the cheekbone (the zygoma) and the frontal bone of the forehead.
Several dangerous fractures that require surgical intervention are the LeFort I, LeFort II, and LeFort III fractures of the maxilla, as defined by Rene LeFort in the early 1990s. These types of fractures are often associated with other severe facial injuries.
What are the Causes of a Facial Injury?
Facial injuries come about through several mechanisms. Some of the ways a face gets injured include:
• Falls from a height
• Assaults and altercations
• Sporting injuries
• Motor vehicle accidents
• Wartime events like gunshots and mortar blasts
• Animal bite injuries
Symptoms of a Facial Injury
The symptoms of a facial injury depend on what kind of injury happens to the individual and the force behind the inciting event. Some symptoms of a facial injury include:
• Facial bleeding
• Bruising of the soft tissue
• Swelling of the soft tissue
• Pain in the face
• Deformity to the face
• Malocclusion of the teeth
• Double vision
• Blurry vision
Diagnosis of a Facial Injury
Diagnosing a facial injury depends on a careful history of what happened along with a physical examination, looking for facial deformities, visual disturbances and malocclusion. Any lacerations are examined with special attention paid to whatever nerve disruption there may be. This means to look for areas of numbness or lack of function of a muscle group.
If there is suspicion for fracture, a plain film x-ray can be done which will show up most of the areas that will be fractured. If there is suspicion of fracture and the plain film x-ray is insufficient, a CT scan of the facial bones can be done which can show up nondisplaced fractures or fractures hidden by other bony areas.
Treatment of Facial Injuries
The first thing to do with facial injuries is to determine if there is a fracture and decide if it needs surgical correction. Generally all of the LeFort fractures need surgical repair and the fractures of the nasal septum need repair. The mandible fractures are usually multiple in nature and need surgical repair in order to ensure proper occlusion of the teeth. The teeth are usually wired shut before repair of these areas to make sure there is normal occlusion. Plates, screws and wires are used to repair these fractures.
Fractures of the nasal bone and frontal bone may not need fracture repair if they will heal spontaneously without displacement.
If there is a laceration over bone it must be assumed that the fracture is an open one. Antibiotics must be given in order to prevent osteomyelitis. The wound must be heavily irrigated before fixing the bone, the soft tissue and the skin, keeping in mind not to disrupt any major nerves, such as the facial nerve.
If there are just lacerations and no fractures, they must be carefully repaired with fine suture. In complicated facial lacerations, a maxillofacial or plastic surgeon should be consulted for the repair. It is better to repair them correctly the first time than it is to repair them after a failed surgery.
Complications of Facial Injury
Most facial injuries are not life-threatening. On the other hand, they are often associated with other dangerous injuries. As a whole, the biggest complication is blockage of the airway secondary to bleeding, localized swelling and disruption of the structure of the airway. Burns especially can swell the airway tissues so that breathing is compromised. Certain broken bones such as those of the mandible, maxilla and nasal bones can cause interference with the airway. Swallowed blood can lead to vomiting, which can interfere with the airway. Airway problems need to be continually monitored because things like swelling can be slow in coming.
Other complications of facial injuries include disfigurement and long term disability that can be emotionally trying. Facial injuries can be associated with the function of the eyes. Fortunately, this is not a common phenomenon.
Muscles and nerves can be trapped by broken bony fragments. For example, fractures of the floor of the orbit can entrap the medial rectus and inferior rectus muscles. Tear ducts can be damaged. If the frontal bone is damaged, it can interfere with the ability of the frontal sinus to drain properly. This can cause a sinus infection.
Infection can also be a complication, especially if the wound is especially dirty or from an animal bite. Prophylactic antibiotics can do a great deal to prevent massive infection.
If you or a loved one has suffered a traumatic facial injury caused by negligence, call me now at (916) 921-6400. If you are outside the Sacramento area, you can call at (800) 404-5400 for free, friendly advice.