ConditionInjuries & poisoning
Facial Fractures: What to Do and How They Heal
Facial fractures are breaks in any of the bones of the face: the nose, cheekbone, eye socket, upper jaw or lower jaw. They usually come from falls, assaults, sports and car crashes. Signs include swelling, bruising, a flattened or uneven face, a bite that feels wrong, double vision or numbness. Many minor fractures heal without surgery, but displaced fractures are often fixed within 1 to 2 weeks, and bones take about 6 weeks to knit.
Also called: Broken facial bones, maxillofacial fractures, facial bone fracture, facial trauma fracture
At a glance
- What it is
- A break in one or more bones of the face, from the nose to the jaw.
- Common causes
- Falls, assaults, sports collisions and road traffic crashes.
- Key signs
- Swelling, bruising around the eyes, a flattened cheek or nose, a misaligned bite, double vision, cheek or lip numbness.
- Diagnosis
- Examination and a CT scan of the facial bones.
- Treatment
- Rest and soft diet for stable breaks. Surgery with small plates and screws for displaced ones.
- Recovery
- Swelling settles in 1 to 3 weeks. Bones heal in about 6 weeks.
When to get help
Call 911 or go to the ER
- Trouble breathing, noisy breathing, or bleeding into the mouth that will not stop
- Loss of consciousness, confusion, repeated vomiting or a severe headache, which suggest a head injury
- Neck pain, or numbness or weakness in the arms or legs: keep the neck still and call 911
- Sudden loss of vision, a bulging eye, or severe eye pain after the injury
- Clear, watery fluid draining from the nose or ears
See a doctor within a day or two
- Double vision, especially when looking up or down
- Teeth that do not meet properly, a jaw that cannot open or close, or loose teeth
- Numbness of the cheek, upper lip, side of the nose, lower lip or chin
- A nose or cheek that looks pushed in or crooked
- A swollen, bluish lump inside the nose (septal hematoma), which needs draining within a day
Book a routine appointment
- A nose that still looks crooked once swelling has gone down after 5 to 7 days
First aid for a suspected facial fracture
- Protect the airway. Sit the person up and leaning forward if they are alert and the neck is not injured, so blood drains out rather than down the throat.
- Assume a neck injury after a high-energy impact such as a car crash or a fall from height. Keep the head and neck still and call 911.
- Control bleeding with gentle pressure. For a nosebleed, pinch the soft part of the nose for 10 to 15 minutes. Do not press on a nose or cheek that looks deformed.
- Apply cold wrapped in a cloth for 15 to 20 minutes at a time to reduce swelling.
- Save knocked-out teeth. Hold a tooth by the crown and keep it in milk or the person's saliva, and get to a dentist or ER within 1 hour.
- Do not blow the nose if a cheek or eye socket fracture is possible. Blowing can force air into the eye socket and cause sudden swelling.
Types of facial fracture
| Fracture | Typical signs | Detailed page |
|---|---|---|
| Nose (nasal) | Crooked nose, nosebleed, swelling, blocked nostril. The most common facial fracture | Nasal fracture |
| Eye socket (orbital floor, "blowout") | Double vision, sunken eye, numb cheek, pain on eye movement | Orbital fracture |
| Cheekbone (zygomatic) | Flat cheek, numb cheek and upper lip, pain when opening the mouth, bruising around the eye | |
| Lower jaw (mandible) | Teeth not meeting, pain when chewing, numb lower lip, bleeding from the gums | Broken jaw |
| Upper jaw (maxilla, Le Fort I to III) | Mobile upper teeth or midface, long-looking face, bite problems, often with other injuries | |
| Forehead (frontal sinus) | Dent in the forehead, sometimes CSF leak |
For a closer look at the anatomy and classification of each type, see facial bone fractures.
How facial fractures are diagnosed
In the ER, doctors first rule out life-threatening problems: airway, bleeding, brain and neck injuries. Facial injuries come with a concussion or other head injury in a significant share of cases.
The face is then examined for step-offs in the bone, movement of the upper jaw, the bite, eye movements and vision, and numbness. A CT scan of the facial bones is the standard test because it shows small fractures and eye socket damage much better than X-rays. Simple nasal fractures may need no imaging at all.
An eye doctor checks vision and the eye itself after any eye socket or cheekbone fracture.
Treatment
Without surgery
Many fractures are stable and line up well. Treatment is:
- pain relief: acetaminophen (paracetamol), or ibuprofen if your doctor says it is safe, following the label dose
- cold packs for the first 48 hours, then warmth
- sleeping with the head raised on 2 or 3 pillows
- a soft diet for jaw and cheekbone fractures
- no nose blowing for at least 2 weeks after sinus, eye socket or cheek fractures
- antibiotics in some fractures that open into the mouth or sinuses
Surgery
Surgery is done when fractures are displaced, affect the bite or eye position, or cause ongoing double vision. Surgeons usually wait for swelling to settle and operate within about 7 to 14 days, though some eye socket injuries with trapped muscle need urgent repair, especially in children.
- Open reduction and internal fixation: bones are realigned and held with small titanium plates and screws, usually through incisions inside the mouth, the eyelid or the hairline so scars are hidden.
- Closed reduction of the nose: the nasal bones are pushed back into place, ideally within about 2 weeks before they set.
- Jaw wiring (maxillomandibular fixation): the upper and lower teeth are held together for several weeks in some jaw fractures. Plates have made long periods of wiring less common.
- Orbital floor repair: a thin implant rebuilds the floor of the eye socket.
Facial fracture recovery time
| Stage | What to expect |
|---|---|
| First 3 to 5 days | Swelling peaks, then starts to fall. Bruising spreads downward |
| 1 to 3 weeks | Most swelling and bruising fade. Return to desk work is often possible |
| 6 weeks | Bones have knitted. Soft diet usually ends for jaw fractures |
| 6 to 8 weeks or more | Contact sports are usually allowed after clearance, sometimes with a face guard |
| Months | Numbness from nerve bruising often improves slowly over 6 to 12 months |
Children heal faster than adults. Smoking slows bone healing.
Possible complications
- Long-term numbness of the cheek, lip or chin
- Persistent double vision or a sunken eye
- A bite that does not meet properly, or jaw joint pain (TMJ disorder)
- Infection of plates or sinuses
- Nasal blockage or a crooked nose
- Visible asymmetry that may need later correction
Frequently asked questions
How do I know if I have a facial fracture?
Warning signs are a face or nose that looks flattened or uneven, a bite that feels different, double vision, numbness of the cheek or lip, pain when opening the mouth, or a crunching feeling when touching the bone. Swelling can hide these, so get checked after any significant blow to the face.
How long does it take to recover from a facial fracture?
Swelling and bruising mostly settle in 1 to 3 weeks. The bones themselves need about 6 weeks to heal. Numbness and minor stiffness can take months to improve. Most people return to light work within 1 to 2 weeks.
Do all facial fractures need surgery?
No. Stable fractures that are well aligned, many nasal fractures and small eye socket cracks heal with rest, a soft diet and follow-up. Surgery is needed when bones are displaced, the bite is wrong, or eye position or movement is affected.
Why can't I blow my nose after a facial fracture?
When a fracture involves the sinuses or eye socket, blowing your nose can push air through the crack into the tissues around the eye, causing sudden swelling and a risk of infection. Doctors usually advise avoiding it for at least 2 weeks.
Can a broken face heal on its own?
Bones will heal, but if they are out of place they heal in the wrong position. That can leave a crooked nose, a sunken cheek, double vision or a bad bite. That is why displaced fractures are realigned within about 2 weeks.
Sources
This guide was written from current patient and clinical guidance, including:
- American Association of Oral and Maxillofacial Surgeons: Facial injuries
- American Academy of Otolaryngology-Head and Neck Surgery: Facial fractures
- MedlinePlus: Facial trauma
- Merck Manual Professional Version: Facial fractures
- American College of Surgeons: ATLS principles for maxillofacial trauma