Facial Fractures

Facial Fractures

Facial bone fractures, or breaks, can occur due to a variety of traumatic events, including:

  • Falls: Particularly common in the elderly or after a loss of balance.

  • Motor vehicle accidents: Often resulting in severe facial trauma.

  • Sports injuries: Especially in contact sports.

  • Industrial accidents: Workplace injuries involving heavy machinery or falls.

  • Assaults: Direct blows to the face can cause fractures.

The face is broadly divided into three regions:

  • Upper Face: This includes the forehead (frontal bone) and upper eye socket (orbital bones).

  • Midface: This comprises the cheekbones (zygomatic bones), the bones around the nose (nasal bones), and the upper jaw (maxilla).

  • Lower Face: This primarily consists of the lower jaw (mandible).

Management of Facial Fractures:

The treatment approach for facial fractures depends on the location and severity of the injury.

  • Mandible (Lower Jaw) Fractures:

    • Due to the mandible's mobility during everyday activities like talking and eating, fractures in this area are typically addressed relatively soon after the injury.

    • Early intervention aims to stabilise the jaw and facilitate proper healing.

    • Treatment often involves surgical fixation with plates and screws.

  • Midface and Upper Face Fractures:

    • For fractures in the midface and upper face, surgery is often delayed for 1-2 weeks.

    • This delay allows for the swelling to subside, enabling a more accurate assessment of the fracture and improved surgical outcomes.

    • Once swelling has reduced, surgery may involve the placement of plates and screws to realign and stabilise the fractured bones.

    • Nasal bone fractures are often reduced in clinic with local anaesthetic.

  • General Considerations:

    • Swelling and bruising are common after facial fractures.

    • Pain management is essential during the recovery period.

    • A soft diet may be recommended to minimise stress on the healing bones.

    • Follow up appointments are very important.

    • In some cases, multiple surgeries might be necessary.

What to expect with Facial Reconstruction Surgery

Following surgical repair of facial bone fractures, also known as open reduction and internal fixation (ORIF), it's essential to understand the typical recovery process. Here's a breakdown of what to expect:

Lower Jaw (Mandible) Fracture Repair:

  • Diet: You will be placed on a soft diet for 4-6 weeks to allow the bones to heal properly. This minimises stress on the jaw joint.

  • Discharge: In many cases, you will be discharged on the same day as your surgery.

  • Recovery: You may experience some discomfort and altered sensation in the jaw area for a few weeks. This is normal and should gradually improve as the healing process progresses. Full return to normal sensation and function can take time.

  • General: Expect some swelling and bruising.

Midface Fractures (Upper Jaw, Eye Sockets, Cheekbones):

  • Hospital Stay: You will typically be kept in hospital overnight for observation.

  • Swelling: Significant swelling is expected and can persist for 4-6 weeks. Applying cold compresses can help reduce swelling.

  • Numbness: You may experience numbness or tingling in the areas around your nose, cheeks, and upper lip. This is due to nerve involvement and can take time to resolve.

  • General: Expect bruising around the eyes and cheeks.

  • Follow up: Follow up appointments are very important to monitor your healing.

General Post-Operative Expectations:

  • Pain management: You will be prescribed pain medication to manage discomfort.

  • Oral hygiene: Maintaining good oral hygiene is crucial to prevent infection. You will receive instructions on how to clean your mouth effectively.

  • Follow-up appointments: Regular follow-up appointments with your surgeon are essential to monitor your healing progress and address any concerns.  

  • Activity restrictions: You will be advised to avoid strenuous activities and contact sports during the initial healing phase.

  • It is important to contact your surgical team if you experience any concerning symptoms, such as increased pain, excessive swelling, fever, or signs of infection.

Risks

Facial fracture repair, while generally successful, carries potential risks that patients should be aware of. Nerve damage is a primary concern, particularly with lower jaw fractures. The inferior alveolar nerve, which supplies sensation to the lower lip, chin, and teeth, and the lingual nerve, responsible for tongue sensation and taste, can be injured during the fracture or surgical repair, leading to numbness, tingling, or taste disturbances. Similarly, midface fractures, such as those involving the eye socket, cheekbone, or upper jaw, can affect the infraorbital nerve, resulting in numbness in the cheek, nose, and upper lip.

A significant risk associated with eye socket and cheekbone fractures is bleeding behind the eye, known as a retrobulbar hematoma. This accumulation of blood can exert pressure on the optic nerve, potentially causing reduced vision or even permanent vision loss. To mitigate this risk, patients with these fractures are typically monitored overnight.

Beyond nerve and visual complications, other risks include infection, which is inherent to any surgical procedure. Improper healing, or malunion and nonunion, can also occur, potentially requiring further intervention. Scarring is unavoidable with surgical incisions, and its extent varies. Jaw fractures may lead to dental occlusion problems, affecting the bite, and midface fractures can cause sinus issues. Finally, due to the complexity of some facial fractures and the potential for complications, additional surgeries may be necessary to achieve optimal outcomes.