Maxillary Fracture (Broken Upper Jaw)

First aid after a facial injury

1. Call 911 for any breathing difficulty, heavy bleeding or loss of consciousness.
2. Keep the airway clear. If the person is conscious and no spine injury is suspected, sitting up and leaning forward lets blood drain out of the mouth.
3. Protect the neck if a spinal injury is possible after a high-energy injury.
4. Control bleeding with gentle pressure, avoiding pressing on unstable bones.
5. Do not blow the nose, which can force air into tissues if the sinuses are broken.
6. Save knocked-out teeth in milk or the person's saliva and bring them along.
7. Apply a cold pack wrapped in cloth to reduce swelling.

Le Fort classification

French surgeon René Le Fort described three classic patterns of midface fracture in 1901. Many real fractures are mixed or one-sided.

Other maxillary fractures include alveolar fractures (the tooth-bearing ridge), sagittal palate splits, and fractures of the front wall of the maxillary sinus, often with cheekbone (zygoma) fractures.

Symptoms

• swelling and bruising of the face, often severe, and around the eyes
• facial pain, worse with chewing
• malocclusion: the teeth no longer fit together, often an open bite at the front
• mobility of the upper jaw or teeth when gently rocked
• numbness of the cheek, side of the nose, upper lip and upper teeth (infraorbital nerve injury)
• nosebleeds and a blocked nose
• a flattened, lengthened ("dish face") or uneven face
• double vision or eye problems if the eye socket is involved
• clear fluid from the nose (cerebrospinal fluid) with Le Fort II and III fractures
• loose or broken teeth

Associated injuries

Maxillary fractures require major force, so other injuries are common:

• head injury and brain injury
• cervical spine injuries
• orbital fractures and eye injuries
• mandibular (lower jaw) fractures
• CSF leaks from skull base fractures
• dental injuries

Diagnosis

• Trauma assessment: airway, breathing, circulation, brain and spine first
• Facial examination: palpation of bones, checking whether the maxilla moves, the bite, nerve sensation, eye movements and vision
• CT scan of the face with 3D reconstructions: the standard test for planning treatment
• Eye examination by an ophthalmologist when orbital involvement is suspected
• Dental assessment

Treatment

Emergency management

Securing the airway is the first priority. Severe midface fractures may need intubation or, rarely, a surgical airway. Bleeding is controlled with packing. Tetanus and antibiotics are given for open fractures.

Non-surgical

Minimally displaced fractures with a normal bite may be managed with a soft diet, pain relief and close follow-up.

Surgery

Most displaced maxillary fractures are repaired, often after swelling settles for several days, by an oral and maxillofacial or plastic surgeon:

• Open reduction and internal fixation (ORIF): bones are realigned and held with small titanium plates and screws, usually through incisions inside the mouth or hidden in natural creases
• Maxillomandibular fixation: temporarily wiring or banding the jaws together to set the correct bite during surgery, sometimes kept for a short time afterward
• repair of associated orbital, nasal and dental injuries

Recovery

• soft or liquid diet for about 4 to 6 weeks
• careful oral hygiene and mouth rinses
• avoid nose blowing for several weeks
• swelling settles over 2 to 4 weeks. Bone heals in about 6 to 8 weeks
• avoid contact sports for at least 2 to 3 months, or as advised

Complications

• malocclusion and chewing problems
• persistent numbness of the cheek and upper lip
• facial asymmetry or flattening
• sinus infection and blocked tear ducts
• double vision from orbital involvement
• infection of plates, or non-union (rare)

Frequently asked questions

What are the symptoms of a maxillary fracture?

Symptoms include facial swelling and bruising, pain, a bite that no longer fits, loose upper teeth, numbness of the cheek or upper lip, nosebleeds and sometimes double vision. A flattened or elongated face suggests a more severe Le Fort fracture.

What is a Le Fort fracture?

Le Fort fractures are patterns of midface fracture. Le Fort I separates the tooth-bearing upper jaw. Le Fort II separates the upper jaw and nose in a pyramid. Le Fort III separates the whole midface from the skull. They are caused by major facial trauma.

Does a broken upper jaw need surgery?

Displaced fractures or those affecting the bite usually need surgery with plates and screws to restore the facial shape and bite. Minimally displaced fractures with a normal bite may heal with a soft diet and monitoring.

How long does a maxillary fracture take to heal?

Bone heals in about 6 to 8 weeks. Swelling improves over 2 to 4 weeks, and a soft diet is usually needed for 4 to 6 weeks. Numbness can take months to improve, and some may persist.

Can you eat with a broken upper jaw?

Yes, usually a liquid or soft, no-chew diet such as smoothies, soups, yogurt and mashed foods for several weeks. Your surgeon will advise when you can gradually return to normal foods. Nutrition supplements help maintain weight.