Facial Trauma & Reconstruction

Facial trauma, also known as maxillofacial trauma, is any injury to the face or jawbone. Facial trauma may include skin lacerations, obstruction to the nasal cavity or sinuses, damage to the orbital sockets, fracture to the cheek, nose or eye socket, and avulsed (knocked out) teeth.

Treatment for facial trauma often involves airway control, bleeding control, reduction of swelling, prevention of infection, repair of bone fractures, lacerations or soft tissue injury, and reconstruction. The most common causes of facial trauma include sporting incidents, accidents, penetrating injuries, and violence. The combination of dental and surgical training makes our Oral and Maxillofacial surgeon uniquely skilled at restoring the aesthetics of facial proportions, the functionality of jaw joints and bites, and damaged or missing teeth.

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). Dr. Young and Dr. McGown are proficient at diagnosing and treating most types of facial lacerations.

Bone Injuries of the Maxillofacial Region

The treatment of facial bone fractures these days is almost always done without the need to wire the jaws together or use external frames or devices. Rigid internal fixation is almost exclusively used to relocate the fractures into their correct anatomical position via cosmetically placed incisions. The use of rigid fixation has profoundly improved the recovery period for many patients allowing them to return to normal function quickly. Grafts of bone, fat, dermis etc. are on occasions required to allow a complete reconstruction of the traumatised tissues.

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

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 are usually involved in treating fractures of the supporting bone or in replanting teeth that have been displaced or knocked out. Therefore, the patient should see a dentist or oral and maxillofacial surgeon as soon as possible. Never attempt to wipe the tooth off, as remnants of the ligament that hold the tooth in the jaw may be 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, 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 now utilised as replacements for missing teeth (see above). The proper treatment of facial injuries is the realm of our MIC specialists who are well versed in emergency care, acute treatment, long-term reconstruction and rehabilitation of the patient.

How facial trauma is repaired

Firstly, the patient will be examined to determine what type of facial trauma is involved. Some of the signs that may be identified include lacerations; 
bruising around the eyes; widening of the distance between the eyes; 
abnormal movement of the jaw when the head is stabilised; and abnormal sensations or irregularities on the cheeks.

Facial trauma is repaired in many different ways, depending on the type of trauma involved. Initially the patient has an examination by the surgeon and may be sent for an x-ray. After a discussion between patient and surgeon, a suitable treatment plan will be formulated. Some methods of repairing trauma to the face may include jaw wiring; the 
placement of “plates and screws” for fractured jaws; 
”replanting” knocked out teeth; 
suturing (or stitching) lacerations. More extensive surgery may be required for extreme injuries.

If major surgery is required, such as jaw wiring or the placement of “plates and screws” for fractured jaws, it will be necessary to have this performed under a general anesthetic at one of the major hospitals. For minor injuries, consultations and treatment are held at the MIC.