Facial Bone Fractures

First aid

• Call 911 for breathing problems, loss of consciousness, heavy bleeding or a possible neck injury.
• Sit the person up and lean them forward to let blood drain from the mouth and nose, unless a spinal injury is suspected.
• Apply cold packs gently, avoiding pressure on the eye or a possibly broken nose.
• Do not blow the nose: with fractures of the sinuses or eye socket, this can force air into tissues around the eye.
• Keep knocked-out teeth in milk and bring them.

For bruises, cuts and general face injury care, see facial injury.

Types of facial fractures

Le Fort fractures

High-energy injuries of the midface are classified as Le Fort I (separating the upper teeth and palate), Le Fort II (pyramid-shaped, through the nose and below the eyes) and Le Fort III (separating the entire face from the skull). These often occur with other serious injuries.

Associated injuries

Facial fractures are frequently accompanied by:

• concussion and other brain injuries
• cervical spine injury
• eye injury, including bleeding behind the eye that can threaten vision
• dental injuries
• CSF leak from skull base fractures

Diagnosis

• Examination: feeling for steps and tenderness along the bones, checking eye movements and vision, testing sensation, checking the bite and mouth opening, and looking inside the nose.
• CT scan of the face: the standard test, with 3D reconstructions for surgical planning.
• Panoramic dental x-ray for jaw fractures.
• Ophthalmology assessment for orbital and midface fractures.

Treatment

Non-surgical

Many stable, minimally displaced fractures heal without surgery:

• soft diet for 4 to 6 weeks for stable jaw fractures
• avoiding nose blowing and pressure changes (such as flying) for orbital fractures
• pain relief, ice and head elevation
• antibiotics for some fractures involving the sinuses or teeth
• closed reduction of a broken nose, often 5 to 10 days after injury once swelling settles

Surgical

Surgery is recommended when fractures:

• cause double vision, a sunken eye or trapped eye muscle
• change the bite or prevent normal mouth opening
• cause visible deformity
• involve the frontal sinus drainage or produce a persistent CSF leak

Surgeons (oral and maxillofacial, facial plastic, or ENT) realign the bones and fix them with small titanium plates and screws, often through incisions inside the mouth, eyelid or hairline to hide scars. Jaw fractures may need the teeth wired or banded together temporarily.

Recovery

• Swelling peaks at 2 to 3 days and mostly settles in 2 to 3 weeks; subtle swelling can last months.
• Bone healing takes about 6 weeks.
• Avoid contact sports for at least 6 to 8 weeks or as advised.
• Numbness from nerve bruising often improves over months, but may be permanent.
• Follow-up checks vision, bite and nasal breathing.

Complications

• double vision or sunken eye (enophthalmos)
• facial asymmetry
• bite problems and jaw joint pain
• numbness of the cheek, lip or chin
• sinus problems, infection or nonunion
• nasal obstruction

Frequently asked questions

What are the signs of a facial fracture?

Signs include swelling, bruising, a flattened or crooked part of the face, numbness of the cheek, lip or chin, double vision, a sunken eye, teeth that do not meet properly, and pain on chewing or opening the mouth. A CT scan confirms the diagnosis.

Do all facial fractures need surgery?

No. Many stable or minimally displaced fractures heal with rest, soft food and pain relief. Surgery is needed when bones are displaced enough to affect vision, the bite, breathing or appearance.

How long does it take for facial fractures to heal?

Facial bones usually heal in about 6 weeks. Swelling mostly resolves in 2 to 3 weeks, but subtle swelling and numbness can take several months to improve. Contact sports should be avoided for at least 6 to 8 weeks.

What is the most common facial fracture?

The nose is the most commonly broken facial bone, followed by the lower jaw, cheekbone and eye socket. Nasal fractures often need no surgery or only a simple reset.

Can you have a broken face bone and not know it?

Yes. Swelling can hide deformity, and some fractures cause only mild pain. Numbness, double vision, a change in your bite, or a step felt along a bone after an injury are reasons to get a CT scan.