Facial fractures are breaks in any of the bones which form the face. These are the mandible or lower jaw, maxilla consisting of upper jaw and nose and the zygomatic bones or cheeks.
Symptoms of a facial fracture
Symptoms vary depending on location and severity, but generally include instant pain, swelling and bruising usually appears. Cuts may be present, especially when the injury was caused by a sharper item. One side of the face may appear deformed compared to the other side. There may be bleeding from the nose or eyes and a straw-colored or pale fluid from the eyes, ears or nose.
Facial fractures occur as a result of a direct impact. This may happen in sports such as rugby where a knee or elbow may impact on the face, hockey or cricket where a hard ball may hit the face, or as a result of a road traffic accident.
Zygomatic arch and orbital fractures
The zygomatic bones form the cheekbones and the lower part of the eye socket. This fracture most often occurs after a fist or a ball has hit the cheekbone. Complications usually involve the eye, such as a sunken eye, altered vision or reduced sensation around the eye.
Treatment may be surgical to reduce displaced bones and surgically fix unstable fractures.
A maxillary fracture is a break in the upper jaw bone, which includes the nose. These fractures may be accompanied by obstruction of the airways, swelling of the soft palate and disturbances of the eye socket.
Initial treatment should be aimed at protecting the airways which are best achieved by sitting the patient leaning forwards. Medical attention should be sought immediately for x-ray diagnosis and any other necessary investigations. Appropriate treatment may involve surgery, using wires, screws or a plate to fix the bones.
Mandibular fractures occur at the lower jaw bone and are the most common form of facial/skull fracture. This injury usually results from a direct blow, such as a punch to the face or being hit with a hardball. Fractures often occur in more than one place and may be displaced or undisplaced.
Undisplaced fractures are generally minor injuries causing pain and swelling. They do not require any treatment other than rest and pain control. It may be necessary for the patient to eat only soft foods for 2-4 weeks to allow the jaw to rest.
Displaced mandibular fractures are more serious injuries which often involve the teeth (alveolar fractures). These can be identified when two or more teeth move together as a unit, separate from the others. They may appear malaligned and the floor of the mouth bruised.
Immediate treatment should involve maintenance of the airways in a forward sitting position. The jaw should be supported by the patient's hand, or by another individual or a bandage or cervical collar.
Most displaced mandible fractures need surgical reduction and fixation to regain to normal position and to allow the bone to heal. This may take 4-6 weeks. In this time, soft food only is permitted and a dietitian should be enlisted for advice to ensure a healthy diet is maintained.