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Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as , and bruises, or bone fracture of the such as and fractures of the jaw, as well as trauma such as eye injury. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.
Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and suturing of open , administration of ice, and analgesic, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury, which commonly accompany severe facial trauma.
In developed countries, the leading cause of facial trauma used to be motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; however auto accidents still predominate as the cause in developing countries and are still a major cause elsewhere. Thus prevention efforts include awareness campaigns to educate the public about safety measures such as and motorcycle helmets, and laws to prevent drunk and unsafe driving. Other causes of facial trauma include falls, industrial accidents, and sports injuries.
| Le Fort I fractures | |
| Le Fort II fractures | |
| Le Fort III fractures | |
Commonly injured facial bones include the nasal bone (the nose), the maxilla (the bone that forms the upper jaw), and the human mandible (the lower jaw). The mandible may be fractured at its symphysis, body, angle, ramus, and condyle. The zygoma (cheekbone) and the frontal bone (forehead) are other sites for fractures.Neuman MI, Eriksson E (2006). pp. 1480–81. Fractures may also occur in the bones of the palate and those that come together to form the orbit of the eye.
At the beginning of the 20th century, René Le Fort mapped typical locations for facial fractures; these are now known as LeFort fracture (right). Le Fort I fractures, also called Guérin or horizontal maxillary fractures,. involve the maxilla, separating it from the palate. Le Fort II fractures, also called pyramidal fractures of the maxilla,. cross the nasal bones and the orbital rim. Le Fort III fractures, also called craniofacial disjunction and transverse facial fractures,. cross the front of the maxilla and involve the lacrimal bone, the lamina papyracea, and the orbital floor, and often involve the ethmoid bone, are the most serious.. Le Fort fractures, which account for 10–20% of facial fractures, are often associated with other serious injuries. Le Fort made his classifications based on work with cadaver skulls, and the classification system has been criticized as imprecise and simplistic since most midface fractures involve a combination of Le Fort fractures. Although most facial fractures do not follow the patterns described by Le Fort precisely, the system is still used to categorize injuries.
A dressing can be placed over wounds to keep them clean and to facilitate healing, and may be used in cases where infection is likely. People with contaminated wounds who have not been immunized against tetanus within five years may be given a tetanus vaccination. Lacerations may require surgical suture to stop bleeding and facilitate wound healing with as little scarring as possible. Although it is not common for bleeding from the maxillofacial region to be profuse enough to be life-threatening, it is still necessary to control such bleeding. Severe bleeding occurs as the result of facial trauma in 1–11% of patients, and the origin of this bleeding can be difficult to locate.Jeroukhimov I, Cockburn M, Cohn S (2004). pp.10–11. Nasal packing can be used to control epistaxis and that may form on the septum between the nostrils. Such hematomas need to be drained. Mild nasal need nothing more than ice and analgesic, while breaks with severe deformities or associated lacerations may need further treatment, such as moving the bones back into alignment and Antibiotics treatment.
Treatment aims to repair the face's natural bony architecture and to leave as little apparent trace of the injury as possible. Fractures may be repaired with metal plates and screws commonly made from Titanium. Resorbable materials are also available; these are biologically degraded and removed over time but there is no evidence supporting their use over conventional Titanium plates. Fractures may also be wired into place. Bone grafting is another option to repair the bone's architecture, to fill out missing sections, and to provide structural support. Medical literature suggests that early repair of facial injuries, within hours or days, results in better outcomes for function and appearance.
Surgical specialists who commonly treat specific aspects of facial trauma are oral and maxillofacial surgeons, otolaryngologists, and plastic surgeons. These surgeons are trained in the comprehensive management of trauma to the lower, middle and upper face and have to take written and oral board examinations covering the management of facial injuries.
Even when facial injuries are not life-threatening, they have the potential to cause disfigurement and disability, with long-term physical and emotional results. Facial injuries can cause problems with eye, nose, or jaw function and can threaten eyesight. As early as 400 BC, Hippocrates is thought to have recorded a relationship between blunt facial trauma and blindness. Injuries involving the eye or eyelid, such as retrobulbar hemorrhage, can threaten eyesight; however, blindness following facial trauma is not common.
Incising wounds of the face may involve the parotid duct. This is more likely if the wound crosses a line drawn between the tragus of the ear to the upper lip. The approximate location of the course of the duct is the middle third of this line.
Nerves and muscles may be trapped by broken bones; in these cases the bones need to be put back into their proper places quickly. For example, fractures of the orbital floor or medial orbital wall of the eye can entrap the medial rectus or inferior rectus muscles.Seyfer AE, Hansen JE (2003). p. 434. In facial wounds, and nerves of the face may be damaged. Fractures of the frontal bone can interfere with the drainage of the frontal sinus and can cause sinusitis.Seyfer AE, Hansen JE (2003). p. 437.
Infection is another potential complication, for example when debris is ground into an abrasion and remains there. Injuries resulting from bites carry a high infection risk.
Facial fractures are distributed in a fairly normal curve by age, with a peak incidence occurring between ages 20 and 40, and children under 12 have only 5–10% of all facial fractures.Neuman MI, Eriksson E (2006). p. 1475. "The age distribution of facial fractures follows a relatively normal curve, with a peak incidence between 20 and 40 years of age." Most facial trauma in children involves lacerations and soft tissue injuries. There are several reasons for the lower incidence of facial fractures in children: the face is smaller in relation to the rest of the head, children are less often in some situations associated with facial fractures such as occupational and motor vehicle , there is a lower proportion of cortical bone to cancellous bone in children's faces, poorly developed sinuses make the bones stronger, and fat pads provide protection for the facial bones.
head injury and brain injuries are commonly associated with facial trauma, particularly that of the upper face; brain injury occurs in 15–48% of people with maxillofacial trauma.Jeroukhimov I, Cockburn M, Cohn S (2004). p. 11. "The incidence of brain injury in patients with maxillofacial trauma varies from 15 to 48%. The risk of serious brain injury is particularly high with upper facial injury." Coexisting injuries can affect treatment of facial trauma; for example they may be emergent and need to be treated before facial injuries. People with trauma above the level of the clavicle are considered to be at high risk for cervical spine injuries (spinal injuries in the neck) and special precautions must be taken to avoid movement of the spine, which could worsen a spinal injury.
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