There are a number of possible causes of facial trauma such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face (cheek, nose, orbit, upper and lower jaw). Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.
SOFT TISSUE INJURIES
When facial lacerations occur they are repaired by suturing providing the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands, salivary ducts (or outflow channels of saliva) and blood vessels.
INJURIES OF THE FACIAL BONES
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age, and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures. One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw.
Certain other types of fractures of the upper and lower jaws, cheek bone and frontal bone are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly. The incisions are designed to be small, placed intraorally and if it is necessary to go through the skin they are hidden to avoid visible scars.
Fractures of the nose are treated with reduction and stabilization with intranasal packing (2-3 days) and external splint (7-10 days). Fractures of multiple bones of the face are called panfacial fractures, the repair of these fractures is more difficult and several hours of surgery are needed to obtain a good result. In some cases additional procedures have to be done to reconstruct the facial structures.
Injuries to the teeth and surrounding dental structures
These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re–inserted into the dental socket, the better chance it will survive.
The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.