Maxillary Fracture
A break in the upper jaw and midface bone
Quick Facts
- Type: Facial bone fracture
- Common causes: Vehicle crashes, assaults, falls, sports
- Bone involved: Maxilla (upper jaw)
- Seek urgent care: Heavy bleeding, airway trouble, vision changes
Overview
A maxillary fracture is a break in the maxilla, the paired bone that forms the upper jaw, holds the upper teeth, and makes up much of the central face. Because the maxilla connects to the cheekbones, nose, eye sockets, and base of the skull, fractures here often affect several structures at once.
These injuries usually result from high-energy trauma to the face. Severe patterns are described using the Le Fort classification (Le Fort I, II, and III), which reflects how far the break extends through the midface. A maxillary fracture can range from a single crack to a complex, unstable injury, and prompt medical evaluation is important to protect the airway, eyes, and bite.
Symptoms
Symptoms depend on how severe the break is and which structures are involved.
- Pain and swelling of the upper jaw, cheek, or midface
- Bruising around the eyes or face
- A bite that no longer fits together correctly (malocclusion)
- Loose, broken, or displaced upper teeth
- Nosebleed or bleeding from the mouth
- Numbness of the cheek, upper lip, or gums
- Difficulty opening the mouth, chewing, or speaking
- A flattened or elongated appearance of the face in severe cases
Clear fluid draining from the nose, double vision, or trouble breathing are warning signs that need emergency care.
Causes
Maxillary fractures are caused by a strong direct force to the midface. Common mechanisms include:
- Motor vehicle and motorcycle crashes
- Physical assault or a blow to the face
- Falls, especially from height or in older adults
- Sports injuries from contact and high-speed activities
- Industrial or occupational accidents
The amount of force needed is usually considerable, so these fractures often occur alongside other facial, eye, or head injuries.
Diagnosis
A clinician examines the face for swelling, asymmetry, tenderness, and an abnormal bite, and checks the eyes, teeth, and nerves. Imaging confirms the diagnosis and maps the break.
- CT scan: The standard test, giving detailed images of the midface bones and any displacement.
- Facial X-rays: Sometimes used as an initial study but less detailed than CT.
- Examination of the bite and tooth stability to plan repair.
Because midface trauma can involve the eye sockets and skull base, doctors also assess for associated injuries.
Treatment
Treatment depends on the location, stability, and displacement of the fracture, and on whether the bite is affected.
- Airway and bleeding control: The first priority in severe injuries is making sure breathing is safe and bleeding is controlled.
- Non-displaced fractures: A stable, well-aligned break may be managed with pain control, a soft diet, and close follow-up.
- Surgical repair (open reduction and internal fixation): Displaced or unstable fractures are realigned and held in place with small titanium plates and screws.
- Restoring the bite: The upper and lower teeth may be temporarily wired or banded together to guide healing into the correct position.
- Antibiotics may be used when the fracture connects with the mouth or sinuses.
Most maxillary fractures heal over several weeks with proper alignment, and dental or jaw rehabilitation may follow.
Complications
Possible complications include:
- A lasting change in the bite or facial shape if not properly aligned
- Infection of the bone, sinuses, or surrounding tissue
- Numbness from injury to facial nerves
- Tear-duct or sinus problems
- Eye or vision problems when the fracture extends to the orbit
Early, accurate repair lowers the risk of these problems.
Prevention
- Always wear a seatbelt and keep vehicle airbags in working order
- Use a properly fitted helmet and faceguard for cycling, motorsports, and contact sports
- Reduce fall hazards at home, especially for older adults
- Wear appropriate protective gear at work
When to See a Doctor
Any significant blow to the face warrants medical evaluation. Call emergency services or go to an emergency department immediately if you have:
- Difficulty breathing or a feeling that the airway is blocked
- Heavy bleeding from the mouth or nose that will not stop
- Clear fluid draining from the nose
- Double vision, loss of vision, or a sunken eye
- Severe facial deformity, confusion, or loss of consciousness
Frequently Asked Questions
How is a maxillary fracture diagnosed?
A doctor examines the face, teeth, and bite, then usually orders a CT scan, which gives detailed images of the midface bones. CT helps determine the exact location, how displaced the break is, and whether nearby structures like the eye sockets are involved.
Does a broken upper jaw always need surgery?
No. A stable, non-displaced fracture may heal with pain control, a soft diet, and close follow-up. Surgery with small plates and screws is used when the break is displaced, unstable, or affects the bite or facial shape.
How long does a maxillary fracture take to heal?
Bone healing generally takes several weeks, often around six weeks for the fracture itself, with full recovery of function taking longer. Following dietary, activity, and follow-up instructions helps the bone set in the correct position.
When is a maxillary fracture an emergency?
Seek emergency care right away for trouble breathing, heavy bleeding, clear fluid from the nose, vision changes, severe facial deformity, or loss of consciousness. These can signal airway, eye, or skull-base involvement that needs urgent treatment.
References
- American Academy of Otolaryngology-Head and Neck Surgery. Facial trauma.
- Mayo Clinic. Broken nose and facial fractures.
- MedlinePlus, U.S. National Library of Medicine. Facial fracture.
- American Association of Oral and Maxillofacial Surgeons. Facial injury and trauma.