Facial Injury: First Aid, Symptoms and When to Get Help

First aid for a face injury

1. Check for danger signs first: breathing, consciousness, heavy bleeding and possible neck injury. If the person was knocked out, fell from a height or was in a crash, keep the head and neck still and call 911 or your local emergency number.
2. Stop bleeding: press firmly on the wound with a clean cloth for 10 minutes without lifting to look. For a nosebleed, sit up, lean forward and pinch the soft part of the nose for 10 to 15 minutes.
3. Reduce swelling: apply ice wrapped in a cloth for 15 to 20 minutes every 1 to 2 hours during the first 48 hours. Do not press hard on the eye or on a possibly broken nose.
4. Keep the head raised: sleep with an extra pillow for the first couple of nights to limit swelling.
5. Clean minor cuts: rinse with running water, cover with a clean dressing, and watch for infection.
6. Pain relief: acetaminophen (paracetamol) is a good first choice. Ibuprofen also eases pain and swelling, but avoid it if there may be a head injury with bleeding risk, or follow advice from a clinician. Follow the label dose.
7. Save teeth: hold a knocked-out tooth by the crown, rinse it briefly without scrubbing, and put it back in the socket or store it in milk or saliva.

Do not blow your nose for several days after a facial injury. If a bone around the eye or sinus is broken, blowing can force air into the tissues and cause sudden swelling.

Face injury symptoms in adults: checklist

Use this checklist to judge how serious a face injury is.

Types of facial injury

Soft tissue injuries

Bruises, abrasions and cuts are the most common facial injuries. The face has a rich blood supply, so cuts bleed heavily but also heal quickly. Facial lacerations usually need closure within about 12 to 24 hours for the best result. Cuts across the lip edge, eyelid, ear or nose need careful alignment to avoid a visible notch or scar. Animal and human bites carry a high infection risk.

Broken facial bones

A hard blow can fracture the nose, cheekbone, eye socket, upper jaw or lower jaw. See facial bone fractures for each type. Common clues:

• Nasal fracture: the most common facial fracture, with a crooked nose, nosebleed and swelling.
• Orbital fracture: double vision, especially looking up, a sunken eye and a numb cheek.
• Jaw fracture: teeth that no longer meet, pain on chewing, numb lower lip or chin.

Eye injuries

Bleeding under the white of the eye, scratches on the cornea, bleeding inside the front of the eye (hyphema) and ruptured globes can all follow a blow to the face. Any change in vision after an injury needs same-day assessment.

Dental injuries

Dental trauma includes chipped, cracked, loosened and knocked-out teeth. A knocked-out adult tooth has the best chance of survival if it is replanted within 30 to 60 minutes.

Head and neck injury

Any blow forceful enough to break facial bones can also cause concussion, bleeding in the brain or a neck injury. People with facial fractures have a higher rate of brain and cervical spine injury.

Is a face injury considered serious?

A face injury is serious if it threatens breathing, sight, the brain, or normal chewing and appearance. It is usually minor if you only have bruising and swelling, can see normally, can bite normally, have no numbness and have no headache, confusion or vomiting.

What a mild facial injury looks like

A mild injury causes tenderness, swelling and bruising at the impact point. Swelling is worst at 24 to 48 hours. Bruises change from red-purple to blue, then green and yellow over 1 to 2 weeks. Bruising can track downward with gravity, so a forehead bump may give two black eyes a day or two later. That alone does not mean a fracture.

How doctors assess a facial injury

The doctor will first check the airway, breathing, circulation and neck. They then examine the face systematically:

• feeling the bones for steps, tenderness or crackling (air in tissues)
• testing eye movements, vision and pupils
• checking sensation over the forehead, cheek, lip and chin
• asking you to open and close your mouth and bite down
• looking inside the nose for a septal hematoma (a collection of blood that needs draining to prevent cartilage damage)
• checking teeth for looseness

A CT scan of the face is the standard test when a fracture is suspected. Plain x-rays are sometimes used for the nose or jaw. A head CT is done if there are signs of brain injury.

Treatment of facial injuries

• Cuts: cleaning, then stitches, skin glue or adhesive strips. Facial stitches are usually removed after 5 to 7 days. A tetanus booster may be needed.
• Broken nose: often reset 5 to 10 days after the injury, once swelling settles, if it is crooked.
• Other fractures: some heal with soft food and rest; displaced fractures need surgery with small plates and screws, usually by an oral and maxillofacial surgeon or facial plastic surgeon.
• Eye injuries: treated by an ophthalmologist.
• Teeth: splinting, root canal treatment or replacement by a dentist.
• Antibiotics: for bites, contaminated cuts and some fractures involving the sinuses.

Recovery and complications

Most soft tissue injuries heal within 2 weeks. Fractures take about 6 weeks to heal. Possible complications include:

• infection of a cut or bite
• scarring, which keeps improving for up to a year
• a persistently crooked nose or breathing difficulty
• numbness from nerve bruising, which often recovers over months
• bite problems after a jaw fracture
• post-concussion symptoms such as headache, poor concentration and fatigue

Protect healing skin from the sun for 6 to 12 months to reduce scar darkening.

Preventing face injuries

• Wear a seatbelt and use proper car seats for children.
• Wear helmets for cycling, motorcycling, skiing and contact sports, with face guards where available.
• Use mouthguards in sports such as hockey, rugby, boxing and basketball.
• Use protective eyewear for racquet sports and DIY work.
• Reduce fall risks at home for older adults: lighting, handrails, removing loose rugs.

Frequently asked questions

Is a face injury considered serious?

It is serious if you have trouble breathing, vision changes, loss of consciousness, confusion, heavy bleeding, a deep cut, numbness, teeth that do not meet, or a crooked nose. Bruising and swelling alone, with normal vision, bite and alertness, are usually minor and heal on their own.

What does a mild facial injury look like?

A mild facial injury causes swelling, tenderness and bruising at the point of impact, sometimes with a small graze. Swelling peaks within 48 hours. Bruises change color from purple to green and yellow, and fade within about 2 weeks. Vision, bite and sensation stay normal.

How long does facial swelling last after an injury?

Swelling is usually worst 24 to 48 hours after the injury and improves steadily over 5 to 7 days. Bruising can take up to 2 weeks to fade. Ice in the first 2 days and sleeping with your head raised help it settle faster.

How do I know if I broke a bone in my face?

Signs of a fracture include a crooked nose, a flattened cheek, double vision, a sunken eye, numbness of the cheek, lip or chin, teeth that no longer fit together, and pain on chewing or opening the mouth. A CT scan confirms it.

Should I go to the ER for a facial injury?

Go to the ER for trouble breathing, heavy bleeding, loss of consciousness, vision changes, signs of a broken bone, a deep or gaping cut, or a possible neck injury. Minor bruises and small cuts can be handled at home or by a primary care doctor or urgent care.