Facial Trauma (Maxillofacial Trauma)

How facial trauma is assessed in the ER

Doctors follow the same order used for all major trauma:

1. Airway: swelling, bleeding, loose teeth and broken jaw segments can block breathing. Some people need a breathing tube or, rarely, a surgical airway.
2. Bleeding: facial wounds bleed heavily because the face has a rich blood supply. Pressure, packing of the nose and, occasionally, procedures to block a bleeding artery are used.
3. Neck: high-energy facial injuries come with cervical spine injury in a notable minority of cases, so the neck is protected until cleared.
4. Brain: facial fractures often accompany head injury and concussion.
5. Eyes: vision and eye movement are checked early, because some eye injuries need surgery within hours.

Once these are safe, the face is examined systematically: feeling for steps and tenderness along the bones, testing sensation in the cheeks, lips and chin, checking eye movement, looking inside the nose and mouth, checking how the teeth bite together, and testing the muscles of facial expression.

Types of facial trauma

Soft tissue injuries

Cuts, scrapes, bites and bruises. Special areas need careful repair: the eyelids and tear ducts, the edge of the lip (the vermilion border), the ear cartilage, and the cheek, where the facial nerve and saliva duct (parotid duct) run. See facial laceration.

Fractures by region

The nose is the most commonly broken facial bone, followed by the lower jaw and cheekbone. More detail on each pattern is in facial bone fractures.

Dental and eye injuries

Broken, loosened or knocked-out teeth are covered under dental trauma. Eye injuries range from bruising to a ruptured globe, bleeding behind the eye, or a detached retina.

Imaging and tests

• CT scan of the face with thin slices and 3D reconstructions is the standard test for fractures.
• CT of the head and neck if brain or spine injury is possible.
• Panoramic dental X-ray for jaw and tooth injuries.
• Eye examination by an ophthalmologist when vision, eye movement or the eyelids are affected.

Plain X-rays have largely been replaced by CT, except for simple nose or jaw injuries.

Treatment

Wounds

Facial cuts heal well because of the good blood supply. They are cleaned thoroughly and closed with fine stitches, skin glue or strips, ideally within 24 hours. Bite wounds get antibiotics. Your tetanus immunization is updated if needed.

Fractures

• Non-surgical care: many fractures that are not displaced and do not affect function heal in about 6 weeks with soft food, pain relief and sometimes antibiotics.
• Broken nose: a displaced nose can be straightened within about 2 weeks, before the bones set, once swelling has gone down. A septal hematoma is drained urgently to prevent cartilage loss.
• Open reduction and internal fixation: surgeons realign the bones and hold them with small titanium plates and screws, usually through incisions hidden inside the mouth, in the hairline or eyelid creases.
• Jaw fractures may need the teeth wired or banded together for a few weeks to hold the bite.
• Timing: surgery is often done within days to 2 weeks, once swelling settles. Airway, eye-threatening and heavily contaminated injuries are treated urgently.

Who treats facial trauma

Oral and maxillofacial surgeons, plastic surgeons, and ear, nose and throat (facial plastic) surgeons all treat facial fractures. Ophthalmologists manage eye injuries and dentists treat tooth injuries.

Recovery

• Swelling peaks at 2 to 3 days and mostly settles in 1 to 2 weeks. Sleeping with your head raised helps.
• Bones take about 6 weeks to heal. Avoid contact sports for at least that long, and wear a protective mask when you return if your surgeon advises.
• After jaw or cheekbone surgery, you may need a soft or liquid diet and careful mouth hygiene with rinses.
• Numbness from bruised nerves often improves over weeks to months but can be permanent.
• Do not blow your nose for about 2 weeks after an eye socket or sinus fracture, as it can push air into the tissues.

Complications

• Breathing problems through the nose
• Double vision or a sunken eye
• Bite problems, jaw joint pain or difficulty opening the mouth
• Persistent numbness or facial nerve weakness
• Infection, sinus problems and visible scarring or asymmetry
• Emotional effects, including anxiety and post-traumatic stress, especially after assault

Prevention

• Wear a seat belt, and a helmet when cycling, riding a motorcycle or skiing.
• Use mouthguards and face shields in contact sports.
• Reduce fall risks for older adults: good lighting, handrails and a review of medicines that cause dizziness.

Frequently asked questions

What is maxillofacial trauma?

Maxillofacial trauma is the medical name for injuries to the face and jaws. It includes soft tissue wounds, fractures of the facial bones, and injuries to the teeth, eyes and nerves. The term comes from "maxilla" (upper jaw) and "facial", and it is the specialty of oral and maxillofacial surgeons.

How do I know if my face is broken?

Signs of a facial fracture include a step or dent in the bone, a crooked nose, a flattened cheek, teeth that do not meet properly, numbness of the cheek, lip or chin, double vision and severe swelling. A CT scan is needed to confirm it. Swelling can hide fractures, so get checked after any hard blow.

Do all facial fractures need surgery?

No. Many fractures that are not displaced and do not affect breathing, vision or the bite heal on their own in about 6 weeks. Surgery is needed when bones are out of place, the bite is wrong, the eye is affected or the face looks clearly changed.

How long does it take to recover from facial trauma?

Bruising and swelling usually settle within 2 weeks. Broken bones take about 6 weeks to heal enough for normal chewing and activity, and up to 3 months to regain full strength. Nerve numbness and scars can keep improving for 6 to 12 months.

Should I see a dentist or a doctor for a face injury?

See a doctor or go to the ER first if there is any head injury, eye problem, difficult breathing, heavy bleeding or a possible broken bone. For an injury limited to teeth, such as a chipped or loose tooth, an emergency dentist is the right choice. A knocked-out adult tooth needs a dentist within an hour.