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Facial trauma
Definition:
Facial trauma is any injury of the face and upper jaw bone.
Alternative Names:
Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries
Causes, incidence, and risk factors:
Blunt or penetrating trauma can cause injury to the midface region, which includes the upper jaw (maxilla). Common causes of facial injury include:
  • Automobile accidents
  • Violence
  • Penetrating injuries
Symptoms:
Findings with trauma in this region include:
  • Difficulty breathing through the nose due to swelling and bleeding in the nasal region.
  • Changes in sensation and feeling over the face
  • Swelling around the eyes may cause limitations in vision.
  • Double vision
  • Missing teeth
Signs and tests:
On physical exam:
  • Lacerations (breaks in the skin) are often seen.
  • Bruising around the eyes and/or widening of the distance between the eyes may indicate injury to the bones between the eye sockets.
  • When the upper jaw moves with the head stabilized, there may be a fracture in this area.
  • Abnormal sensations on the cheek and irregularities that can be felt on the facial region can indicate fractures.
  • The physical exam is often complimented by a CT scan of the head.


Treatment:
When the patient is unable to perform any normal function, or a substantial cosmetic deformity occurs, the treatment is usually surgical. Goals include:
  • Establish a clear airway.
  • Control bleeding.
  • Treat the fracture.
  • Rule out other injuries.
  • Fix broken bone segments with titanium plates and screws.
  • Use existing lacerations and incisions in the mouth and around the eye and scalp during surgery to minimize scarring.
  • Treatment should be immediate, as long as the patient is stable and cleared of all life-threatening injuries and the neck has been cleared of fractures.
Expectations (prognosis):
Patients generally do very well with proper pre-operative workup and planning. The patient should be fore-warned that they will most likely look different from their pre- injury state and that revision surgeries may be necessary 6 to 12 months later.
Complications:
General complications include, but are not limited to:
  • Bleeding
  • Infection
  • Neurologic complications
  • Facial asymmetry
Calling your health care provider:
Go to the emergency room or call the local emergency number (such as 911) if you have a severe injury to your face.
Prevention:
Wear seat belts and use protective head gear when appropriate. Avoid triggering potentially violent confrontations with other people.
Review Date: 11/18/2002
Reviewed By: Hebe Molmenti, M.D., Ph.D., Private Practice specializing in Plastic and Reconstructive Surgery, Baltimore, MD. Review provided by VeriMed Healthcare Network.

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