Maxillofacial Fractures in the Elderly

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November 05, 2012
Edward Smith

There has been a great deal of research on maxillofacial injuries in normal individuals but little research has been done on these types of fractures in the elderly. Maxillofacial fractures can occur anytime a person is thrust forward in an accident and the facial area strikes the dashboard or the steering wheel. Some fractures can happen in unrestrained people in the back seat who strike the back of the front seat.

Most maxillofacial fractures in the general population are mandibular and nasal bone fractures. The mandible is the jaw bone that holds the bottom teeth and that allows the jaw to open and shut in talking, yawning and chewing. When it breaks, it can break in the middle (the symphysis) along the body, angle, subcondylar region or condyle of the mandible. Other facial fractures include orbital fractures around the eyes, and fractures of the delicate nasal bones.

Many of these fractures can affect a person’s bite so that their teeth are not lined up the way they are supposed to be. When fixing these fractures, doctors need to make sure the bite is perfect before setting the bone. The bones can be fixed by putting them back in proper alignment and wiring the jaw shut to protect the bony fragments and assure tooth alignment. They can also be fixed by doing a surgical operation so that plates and screws can be used to permanently align the bones.
As mentioned, little has been discussed in the literature on the maxillofacial fracture status of elderly patients, who can be injured in falls or car crashes. One study looked at 45 elderly patients aged 65 or older and 201 younger patients who sustained a maxillofacial injury. The study noted a greater percentage of nasal bone fractures in the elderly population when compared to younger people who had more mandibular fractures.

Car crashes still accounted for more than half of the maxillofacial injuries in the elderly but there were more injuries sustained from falls in the elderly population than in the regular adult population. The biggest problem in elderly patients was that they commonly sustained multiple injuries, some of them worse than their maxillofacial injuries so that the facial injuries don’t get repaired until the more serious internal injuries and fractures get managed.

Elderly patients stayed in the hospital for their fractures much longer than younger adults. This is because of their other injuries and because they have more underlying medical problems when compared to younger people. Their fractures heal more slowly and they don’t tolerate having their jaws wired shut as much as younger people due to being thinner and already malnourished, in some cases.
Fortunately, the treatment of nasal bone injuries in the elderly is relatively simple. They can undergo closed reduction or no reduction at all, depending on alignment and can wear a splint to allow for healing of the nasal bone or nasal septum. If the patient sustains a mandibular fracture, they can have surgical repair of their injury to speed healing.