Facial Trauma

The Oral and Maxillofacial Surgeon performs the proper treatment of facial injuries. They are 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 patient’s long term function and appearance.

Injuries to the face, jaws, and teeth are common. Motor vehicle accidents, occupational mishaps, interpersonal violence, and recreational accidents are all frequent causes of facial trauma. Your oral and maxillofacial surgeon is uniquely qualified to diagnose and treat these injuries. Our thorough understanding of facial anatomy and general trauma management skills combined with our additional dental training affords us unrivaled skills to manage the full scope of facial and dental traumatic injuries. From an uncomplicated tooth injury to devastating multiple facial fractures, our background and experience allows us to offer truly comprehensive trauma management and return our patients to their preaccident condition, restoring anatomical form and proper function.

Facial lacerations
Intra oral lacerations
Avulsed (knocked out) teeth
Fractured facial bones (cheek, nose or eye socket)
Fractured jaws (upper and lower jaw)

When and Where to Seek Treatment for Facial Trauma

If you have been injured and you have any doubt about the need to seek medical care, you should consult with a care giver to at least help you assess the seriousness of your injuries. Anytime there has been a loss of consciousness following head trauma, no matter how brief, you should consult with an emergency care facility or your physician. If you have suffered a facial injury and there is a noticeable change in your appearance, eyesight, breathing, occlusion (bite), swallowing or speaking, you should seek medical care. Frequently fractures of bones of the face are accompanied by subtle changes. Double vision, visual blurriness, pain behind the eye may represent a fracture to the orbit (eye socket) and/or cheekbone. The sensation of teeth being out of place or loose, or the sensation that the occlusion (bite) is off often indicates a fracture of the upper or lower jaw. Numbness or tingling to the skin of the face and lips can also point to a significant injury. In short, if you feel that something unusual is happening, you should at least seek consultation with a professional to evaluate the seriousness of the injury.

If the injury is severe or it has caused you to become unconscious you should be evaluated in one of the local emergency rooms. Our surgeons are on staff at all the local hospitals and can be called to evaluate you there. The most severe injuries to the face and jaws are generally treated in the hospital. If the injury is less severe, you can contact us directly and we can evaluate and usually treat you in one of our offices. Our offices are equipped to provide care for a wide range of injuries to the face and jaws and we can provide care for patients that includes repair of lacerations, stabilization of loose teeth, fixation of facial bone fractures, and the treatment of other injuries. These treatments can be performed under general anesthesia for painless surgery. Our surgeons are uniquely qualified to provide outpatient anesthesia, analgesia, and state of the art treatment of injuries of the face, jaws and teeth. If you or someone you know has sustained a significant injury that involves the face, the jaws or the teeth, please contact us for a consultation.

Soft Tissue Injuries of the Maxillofacial Region

The soft tissues of the face include the skin and the lining tissue of the mouth, known as mucosa. Contusions and bruises typically are managed expectantly as intervention is rarely necessary. Cuts, or lacerations, of the soft tissues are almost always closed with sutures, adhesive strips or tissue cements. This ensures the best cosmetic result as well as minimizing the chance of complications due to infection or scarring. In the facial region, skin sutures are most commonly placed soon after the injury and removed 5 days later to decrease the chance of scar formation. Inside the mouth, most commonly resorbable sutures are used which will dissolve and fall out 5 to 10 days following placement.

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. However, most of the fractures of the bones of the face can be treated with very small titanium plates and screws that allow the bones to heal without the need for limitation of jaw movement. The fracture heals by being held in place by the plates and the patient can continue to function without the drawback of having the teeth wired together. If the fractures are very unstable, the patient may need to have the jaws wired together for a short period of time. There are some particular types of fracture where the option of a short period of intermaxillary fixation (being wired shut), typically 7-10 days, results in a better outcome than the alternative of rigid bone plate fixation without the need for open surgery. Your doctor will discuss all of these alternatives with you at the time of your consultation and afford you an opportunity to make an informed decision about your treatment.

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. State of the art techniques used by our surgeons to repair facial fractures allow us to reach most facial fractures, using no skin incisions. By placing incisions inside the mouth or inside the lower eyelid for example, most jaw, cheekbone and orbital fractures can be repaired without incisions on the face. Occasionally the severity of the injury necessitates a skin incision. These are generally placed in a skin fold under the jaw or behind the hairline so as to camouflage them and once healed are nearly imperceptible. If the patient or the surgeon notices an unsatisfactory scar, this can be improved by scar revision techniques.

Injuries to the Teeth and Surrounding Dental Structures

Injuries to the teeth are very common. If the teeth have been knocked completely out, remember that in terms of the survival of the teeth, time is of the essence.

Try to find the teeth, rinse them with some plain cool water without scrubbing them and place them in one of the following places:

The tooth or teeth should ideally be gently but firmly placed back into their sockets as this is the most physiologic environment.
Alternatives include cool milk, saline, or water.
In the mouth, under the tongue may be another suitable choice if the patient is awake and alert.

Contact us and we will try to treat you as soon as possible. Often the teeth can be reimplanted and splinted or braced to the neighboring teeth and they will survive. Sometimes the bone that holds the teeth (alveolar process) is also fractured and needs to be stabilized with a type of wire similar to orthodontic braces. If the teeth have been loosened but not avulsed (knocked out) and your bite feels off, these teeth may be repositioned and splinted for proper healing. Under most circumstances this type of injury can be treated with excellent results and, assuming the teeth are reimplanted quickly, most can be saved.

The majority of avulsed teeth will also need endodontic (root canal) therapy to prevent their loss after the initial healing period. Remember that the time the tooth is out of its socket is the most critical factor in determining its eventual survival or loss. When the time out of the socket exceeds two hours most will not survive even with aggressive treatment. If the teeth do not survive they can be replaced by implants and new teeth fabricated to replace those lost. If you have such an injury call the on-call doctor at Austin Oral Surgery or your dentist immediately so that care may be rendered in a timely fashion.

The proper treatment of facial injuries is the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction and rehabilitation of the patient.

Patient Education

Facial Cosmetic Surgery