Facial Trauma
Injuries to the face, by their very nature,
impart a high degree of emotional, as well as physical trauma to
patients. The science and art of treating these injuries requires
special training involving a "hands on" experience and an
understanding of how the treatment provided will influence the
patient's long term function and appearance.
Oral and Maxillofacial Surgeons are on staff at local hospitals
and deliver emergency room coverage for facial injuries, which
include the following conditions:
- Facial lacerations
- Intra-oral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones (cheek, nose or eye socket)
- Fractured jaws (upper and lower jaw)
The Nature of Maxillofacial Trauma
There are a number of possible causes of facial trauma such as
motor vehicle accidents, accidental falls, sports injuries,
interpersonal violence and work related injuries. Types of facial
injuries can range from injuries of teeth to extremely severe
injuries of the skin and bones of the face. Typically, facial
injuries are classified as either soft tissue injuries (skin and
gums), bone injuries (fractures), or injuries to special regions
(such as the eyes, facial nerves or the salivary glands).
Soft Tissue Injuries of the Maxillofacial Region
When soft tissue injuries such as lacerations occur on the face,
they are repaired by suturing. In addition to the obvious concern
of providing a repair that yields the best cosmetic result
possible, care is taken to inspect for and treat injuries to
structures such as facial nerves, salivary glands and salivary
ducts (or outflow channels).
Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner
similar to the fractures in other parts of the body. The specific
form of treatment is determined by various factors, which include
the location of the fracture, the severity of the fracture, the age
and general health of the patient. When an arm 
or a leg is fractured, a cast is
often applied to stabilize the bone to allow for proper healing.
Since a cast cannot be placed on the face, other means have been
developed to stabilize facial fractures.
One of these options involves wiring the jaws together for
certain fractures of the upper and/or lower jaw. Certain other
types of fractures of the jaw are best treated and stabilized by
the surgical placement of small plates and screws at the involved
site. This technique of treatment can often allow for healing and
obviates the necessity of having the jaws wired together. This
technique is called "rigid fixation" of a fracture. The relatively
recent development and use of rigid fixation has profoundly
improved the recovery period for many patients, allowing them to
return to normal function more quickly.
The treatment of facial fractures should be accomplished in a
thorough and predictable manner. More importantly, the patient's
facial appearance should be minimally affected. An attempt at
accessing the facial bones through the fewest incisions necessary
is always made. At the same time, the incisions that become
necessary, are designed to be small and, whenever possible, are
placed so that the resultant scar is hidden.
Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the
expertise of various dental specialists. Oral surgeons usually are
involved in treating fractures in the supporting bone or in
replanting teeth that have been displaced or knocked out. These
types of injuries are treated by one of a number of forms of
splinting (stabilizing by wiring or bonding teeth together). If a
tooth is knocked out, it should be placed in salt water or milk.
The sooner the tooth is re-inserted into the dental socket, the
better chance it will survive. Therefore, the patient should see a
dentist or oral surgeon as soon as possible. Never attempt to wipe
the tooth off, since remnants of the ligament that hold the tooth
in the jaw are attached and are vital to the success of replanting
the tooth. Other dental specialists may be called upon such as
endodontists, who may be asked to perform root canal therapy,
and/or restorative dentists who may need to repair or rebuild
fractured teeth. In the event that injured teeth cannot be saved or
repaired, dental implants are often now utilized as replacements
for missing teeth.
