How Are Facial Fractures Treated?

Facial fractures are treated with surgery.

Patients with facial fractures are usually seen and treated in the emergency department. The definitive diagnosis usually requires imaging in the form of a computed tomography (CT) scan. This aids in both the diagnosis and treatment planning of the facial fracture.

• The majority of patients with facial fractures can be seen in the surgeon’s clinic on an outpatient basis.
• If surgery is needed, it typically occurs one to two  weeks after the injury. This time period allows for facial swelling from the original injury to decrease substantially, which makes the surgery safer and more precise. However, waiting too long (more than two to three weeks) increases the risk of malunion (fractures healing with the bones in the incorrect place).

Certain situations require more urgent care

• Open fractures of the mandible, fractures of the frontal sinus and skull base, fractures with injuries requiring surgery from the neurosurgery team and certain orbital fractures (fracture of the eye socket) may require urgent care. In addition, patients with extensive injuries to the facial soft tissues may also require expedient care. Often, soft tissue repair is performed at the time of injury and facial fractures are repaired after the swelling has gone down.

Management

• Orbit: Orbital  (eye socket) injury is treated as an  emergency or it can lead to permanent scarring of the muscles involved. The repair process involves exposing the bony rim of the orbit through an incision made inside the lower eyelid. The fractured floor is identified. Any prolapsed tissue or entrapped muscle is pulled up and the floor is repaired. A titanium mesh is used most commonly. Silicone sheeting or bony grafts can be used as well.
• Cheeks (maxilla and zygoma): The cheek bone is attached to four different bones in the face. Usually, a fracture of this bone causes a quad-pod or tripod fracture. The bone usually rotates after the fracture. It has to be reduced (pushed back into the normal position) and then fixed internally (held in place) with plates and screws.
• Mandible (jaw bone): The lower jaw is a strong bone. In mandible fractures, the critical thing is to get the occlusion right (make sure the upper and lower teeth meet like they did before the injury). The jaws usually have to be wired together with arch bars. Then, the fractured bone fragments are held together and plated.
• Nasal bone fractures: These are among the most fractured bones in the human body. Fractured nasal bones benefit from repair if there is displacement sufficient to create a deformity or affect breathing. Repair of most nasal fractures involves a closed nasal reduction. The bones are shifted back into place and held in place by a splint. If there is also a fracture of the nasal septum (center of the nose dividing the left from right), this may also be reduced and splinted at the time of surgery.

Pediatric facial fractures

• The mandible (lower jaw) and maxilla (upper jaw) in children contain both the primary and secondary (adult) teeth. The facial bones in children are more elastic and less brittle than those in adults. Each of these factors makes fractures of the midface less common in children and fractures of the skull and frontal bones more common. In addition, facial fractures in children are less likely to be significantly displaced compared with those in adults. It is important that facial fractures in children be managed by experienced doctors to minimize the potential impact on future facial growth.
• Often, a facial fracture may be left to heal on its own. No treatment may be necessary if the broken bones stay in a normal position, but injuries causing severe fractures may need to be surgically repaired. The surgeon moves the bone(s) back into their normal position. In some cases, special wires, screws or plates may be needed to join the bones together.

Summary

• A facial fracture may involve any number of broken bones in the face including the nose, jaw or cheekbones. These injuries are not only very painful, but they also require advanced surgery by a qualified surgeon to restore physical appearance and prevent future problems with breathing, speaking or eating.
• Facial fracture surgery may need to be performed in stages. An initial treatment is performed as soon as possible after the injury or incident. This might be followed by a second surgery performed months, or sometimes years, after the first. The course of treatment depends on how age and other changes impact the results of the earlier surgery. The extent of the initial injury is a factor as well.
• Often, a combination approach is used for the best results. For example, wires, plates and screws can be used to stabilize the bone structure, whereas dermal fillers can be used to restore lost volume in the soft tissue. In cases of nasal injury, cosmetic surgery may be necessary to address the physical appearance of the nose, whereas internal damage may require an extensive surgery.