Oral & Facial Trauma (Injuries)

The basis of much of our training as Oral and Maxillofacial Surgeons, is trauma. In fact, many of the reconstructive techniques commonly used today, are of origin and developed out of necessity, to repair traumatic injuries of the facial skeleton. Our natural comfort with caring for the facial trauma patient is therefore apparent. A bulk of current literature with respect to facial trauma is found in the Oral and Maxillofacial Surgery literature.

Facial trauma is frequently treated by overlapping surgical specialties, including Plastic Surgery, Otorhinolaryngology (ENT), and Oral and Maxillofacial Surgery. Unfortunately, training and experience do not have commonality between these specialties or for that matter within the specialties. Surgical residency training differs greatly in the volume of experience and scope of care provided. Therefore, one cannot assume surgical expertise merely by evidence of specialty training or title.

The dental specialist performs the proper treatment of facial injuries. These professionals must be well versed in emergency care, acute treatment and long-term reconstruction and rehabilitation not just for physical reasons but emotional as well. Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat 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 patients long term function and appearance.

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). Our doctors are well-trained oral and maxillofacial surgeon and is proficient at diagnosing and treating all types of facial lacerations.

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.

The following types of facial trauma cases are routinely treated:

  • Mid-facial fractures (LeForte I, II, & III type facial fractures)
  • Zygomatic arch and Zygomatic Complex (cheek bone) fractures
  • Naso-orbital-ethmoid (NOE) fractures
  • Orbital Rim and Orbital Wall fractures (orbital blow out fractures)
  • Nasal fractures
  • Mandibular (lower jaw) fractures
  • Dental and Dentoalveolar injuries (teeth and adjacent structures)
  • Facial soft tissue injuries (simple and complex facial lacerations)
  • Missile and penetrating injuries to the facial skeleton (gun shot and stab wounds to the face)
  • Injuries to the Teeth and Surrounding Dental Structures

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 and Maxillofacial Surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which 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).

What to do if a Tooth is Knocked Out? 

If a tooth is “knocked out”, it should be rapidly placed back in the tooth socket if at all possible. Deciduous (baby) teeth are generally not replanted due to their poor success.

Keeping the tooth moist is most critical. Other alternatives include placing the tooth in the mouth between the cheek and gum, placing the tooth in dilute salt water (tsp salt in 8 -12 oz glass of water) or milk. The sooner the tooth is re-inserted into the dental socket, the better for the survival of the tooth. Therefore, the patient should see a dentist or oral & maxillofacial surgeon as soon as possible. Never attempt to “wipe the tooth off”, since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. You may gently rinse the tooth of before reinserting into the socket.

Other dental specialists may be called upon such as an endodontist, 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.

If you have any questions with regards to our scope of trauma services please do not hesitate to contact us.