FACIAL FRACTURES

Facial fractures are any break to any of the bones of the face, usually the upper or lower jaw, the cheekbone or eyesocket or the nose. The fracture may also involve facial lacerations.

Fractured Lower Jaw (Mandible)

The mandible may also be referred to as the ‘lower jaw’.

Mandibular fractures are common and usually result in pain, swelling, limited movement and a change in occlusion (or ‘bite’). On some occasions, teeth may be dislodged as a result of a mandibular fracture. Some people may also experience a change in sensation (feeling) over their lower lip or chin as a result of a mandibular fracture.

Most mandibular fractures will require admission to hospital and surgery to align the fractured bone which is then held in position by plates and screws or wires. The goal of the surgery is to re-establish the dental occlusion and return the alignment of the bone to that which existed prior to the break occurring.

During the operation your teeth will be held together in their correct bite. This may involve the placement of screws between your teeth to allow wire fixation, or wiring a metal band, called an Arch Bar, around the maxillary and mandibular teeth to allow wiring of the jaws together. Most mandibular fractures can be treated without the requirement for your jaws to be wired together after surgery, although elastic bands, similar to those used by Orthodontists, may be used over the healing period to ensure your bite remains in the correct position.

Fractured Upper Jaw (Maxilla)

The maxilla may also be referred to as the ‘upper jaw’.

Maxillary fractures are relatively uncommon and usually result in pain, swelling, limited movement and a change in occlusion (or ‘bite’). On some occasions, teeth may be dislodged as a result of a maxillary fracture. Some people may also experience a change in sensation (feeling) of the teeth in the maxilla or the skin of the cheek and upper lip as a result of a maxillary fracture.

Maxillary fractures may occur at different levels of the face. A common classification system for maxillary fractures was devised by Henri Le Fort around the turn of the 20th century. Depending upon the level of the maxillary fracture various other bones may also be broken and different treatment required.

Often maxillary fractures will require admission to hospital and surgery to align the fractured bone with the other facial bones, which are then held in position by plates and screws or wires. The goal of the surgery is to re-establish the dental occlusion and return the alignment of the bone to that which existed prior to the break occurring.

During the operation your teeth will be held together in their correct bite. This may involve the placement of screws between your teeth to allow wire fixation, or wiring a metal band, called an Arch Bar, around the maxillary and mandibular teeth to allow wiring of the jaws together. Most maxillary fractures can be treated without the requirement for your jaws to be wired together after surgery, although elastic bands, similar to those used by Orthodontists, may be used over the healing period to ensure your bite remains in the correct position.

Fractured Orbit

The orbit (or eye socket) is the name given to the cavity containing the eye (globe) and its supporting structures (fat, muscles, blood vessels etc).

Fractures of the orbit may result in blindness or impaired vision, altered sensation over the cheek, pain, bleeding into the maxillary sinus with drainage of blood from the nose and an alteration in facial symmetry.

Orbital fractures may occur alone or in combination with other fractures of the facial skeleton (most commonly the zygomatic complex (cheekbone).

The most important assessment in trauma to the orbit is whether there has been, or is likely to be blindness or altered vision as a direct result of the injury or due to changes occurring as a result of the injury.

Swelling in the first 7 – 10 days often makes surgery difficult and it is not uncommon to delay intervention until this initial period of acute injury has passed. This may also allow better assessment of whether surgical reconstruction is required. This is the reason you may not be offered an appointment with your surgeon until a few days after the injury, particularly if your referring doctor has determined there is no risk to your vision.

A CT scan is mandatory to assess the location and extent of the fracture and helps guide your surgeon as to whether reconstruction is necessary.

Surgery to reconstruct a fractured orbit is generally undertaken with incisions in the conjunctiva (mucosa beneath the lower eyelid) and does not result in a visible facial scar. Depending upon the injury it may be necessary to place an implant eg titanium mesh beneath the orbital contents to reconstitute the orbital cavity. These implants are not removed and are quite safe in the longer term.

Following surgery swelling is again a feature and may result in double vision that generally settles as the swelling around the eye resolves. Sensation to the cheek usually improves but will usually take months.

Follow-up is required in the postoperative period and depending upon the injury and progress following surgery may be required for up to 6 months.

Fractured Cheekbone (Zygoma)

The zygoma (or cheekbone) is the name given to the bone that forms the prominence of the cheek. It also forms part of the eye socket (lateral and inferior margins) and connects to the frontal bone (forehead) and maxilla (upper jaw).

Zygomatic fractures may involve only a projection on the side of the face (zygomatic arch fracture) or they may involve the complete bone (zygomatic complex fractures).

Isolated zygomatic arch fractures present with a depression (dent) in front of the ear, and may also cause pain and limited opening of the jaw.

Zygomatic complex fractures usually also involve the zygomatic arch but may additionally cause blindness or altered vision if involving the eye socket (orbit), altered sensation over the cheek and maxillary (upper) anterior teeth on the side of the fracture, pain and altered facial symmetry. Bleeding into the maxillary sinus associated with these injuries may also drain through the nose, mimicking a nose bleed (epistaxis).

A CT scan is necessary for thorough assessment of the extent of the injury and may help guide the decsision regarding surgery.

Surgery for an isolated zygomatic arch fracture usually does not involve the use of plates and screws.

Surgery for a zygomatic complex generally involves the use of plates and screws to hold the bone in its correct position and may need to be placed at multiple sites where the zygomatic bone articulates (joins) with other bones. If the orbit is also fractured it may be necessary to reconstruct this area too. The implants used are not generally removed and are quite safe in the longer term.

Following surgery swelling may take several weeks to resolve. Sensation to the cheek and teeth usually improves but will usually take months.

Follow-up is required in the postoperative period and depending upon the injury and progress following surgery may be required for up to 6 months.