Oral Surgery Procedures | Southern California Center for Oral and Facial Surgery

Facial Trauma

Oral and maxillofacial surgeons are trained to treat a wide variety of injuries to the mouth, face and jaws. Our doctors are specialists in the repair of lacerations to the lips and face, and fractures to the teeth and facial bones.We are often called to emergency rooms to evaluate and treat facial injuries. Fractures(broken bones) can involve the lower jaw, upper jaw, cheek bones, eye socket, and combinations of these bones. Treatment frequently requires hospital treatment, however many of the less serious injuries can be treated in the office.

Some of the signs and symptoms of facial fractures are:

Pain

  • Numbness of the lip, cheek, tongue, nose
  • Change in the bite
  • Visible step-off between teeth
  • Deep laceration over bone

The principles of treatment for facial bones are the same as for a broken arm or leg. The parts of the bones must be lined up (reduced) and held in position long enough to allow them to heal (stabilization and/or fixation). This may require six weeks or more, depending on the patient's age and the complexity of the fracture.

Simple fractures are treated by "closed reduction," which means simple manipulation of the fractures segments without major surgery. These are usually stabilized by splints or other simple devices. For fractures of the jaws, this usually means "arch bars," which utilize the teeth for fixation.

The patient's jaws are "wired together" for about 6 weeks, during which time they are on a liquified diet.

This technique is appropriate for a majority of jaw fractures, and avoids surgery, which can cause scarring and can have a greater risk of complications.

This patient has an obvious fracture visible between these two teeth. The fracture extends the entire width of the lower jaw bone.

This patient fractured his upper jaw in an automobile accident. Notice how his teeth no longer come together properly. (The white arrows should line up.)

More complicated facial fractures frequently require "open reduction," which means that surgery is performed to directly line up and stabilizes the bone segments. When this is done, the fracture is usually stabilized using wires or bone plates and screws. This usually eliminates the need for the jaws to be wired together, but is a more invasive procedure.




Here are some examples of patients treated by our surgeons

Case 1:

This 6 year old boy fell out of a second floor window onto his face.

The arrows in this 3-D CAT scan show the locations of the fractures. One was located in the middle of the lower jaw (mandible). On both sides, there were additional fractures just below the joints.

This chin laceration occured in the fall just over the area of one of the fractures (notice the ivory color of the mandible in the middle of the opening). It was enlarged so that a plate could be placed to stabilize this fracture.

The fractures near the joints were treated by arch bars and rubber bands to stabilize the segments for healing, but prevent freezing (ankylosis) of the joints. The chin incision healed well, and is barely visible, except to close examination.

One year after the injury, the patient had normal jaw opening and movement, and normal function.

Case 2:

This 35 year old man was injured riding his motorcycle by a plumbing pipe sticking out from a truck that backed out of a driveway in front of him. He was going about 35 mph and unable to stop. The pipe struck him in the face, crushing the cheek and floor of the eye socket. 

The fracture was repaired by multiple approaches- through the lower eyelid, mouth and eyebrow - until the cheek and orbital floor were reconstructed. The bony fragments were held in place by miniature bone plates and screws.

Case 3:

This 88 year old woman with Alzheimer's disease fell at home and struck her face. The blow was so great that it broke her right jaw. The surrounding muscles caused a significant displacement of the bone segments. The bony edges have been highlighted for clarity.

At surgery, the fracture was repaired with two bone plates, to rigidly hold the fragments together. This allowed her to eat and swallow without interference, so she was able to maintain her food intake and heal uneventfully.