The maxillofacial surgeon is frequently called in to manage 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 require 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.
Causes of Facial Trauma
There are numerous causes of facial trauma such as gunshot wounds, stabbings, motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from simple lacerations and fractures to crushing injuries of the face or total avulsion of facial structures.
Facial Trauma Treatments
When soft tissue injuries such as lacerations occur on the face, it is 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 surgeons and are proficient at diagnosing and treating all types of facial lacerations.
Fractures of the facial bones are treated in a manner similar to 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 the 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.
Certain 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 the “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation have 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.
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 avulsed. 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 avulsed, it should be placed inside the mouth alongside the cheek. Otherwise, the next best option is storing in 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. If the event occurs after hours, proceed to an Emergency Room. 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. If injured teeth cannot be saved or repaired, dental implants are often utilized as replacements for missing teeth.
The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.