Here’s what you should know about reconstructive facial surgery performed by Randolph C. Robinson, MD, DDS, FAACS, as treatment for facial trauma in Denver, CO:
Facial trauma occurs for a variety of reasons including motor vehicle accidents, assaults, falls, sports injuries, and domestic violence. Some of these injuries can be minor cuts and scrapes. But some can be major injuries involving fractures of the facial bones and skull.
The key to repairing facial injuries is to restore form and function. Understanding the mechanism of injury is helpful in making sure that associated injuries are not overlooked, such as a neck fracture or damage to an eyeball itself.
In the case of facial bone fractures the best course of treatment is surgery to put the bones in their proper positions, called reduction. Then the bones must be held in that position by either wires, metal bone plates, screws, and/or inactivity. This effort is called stabilization. Reduction and stabilization must occur for the bones to heal in their proper positions with solid bone filling in the fracture site.
If you are disfigured or have irregular discomfort, surgery might be the right option for you. Surgical treatment options may be covered by your insurance. Please contact your insurance provider for coverage details. In some cases, surgery may be considered an elective cosmetic procedure. Contact our office to schedule an appointment to see Dr. Robinson to determine the best treatment plan for you.
Fractures can be treated either open or closed. These terms mean that the bones are either surgically exposed so that the surgeon can directly see the break (open), or so that he/she feels the bone fracture through the soft tissue (closed).
There are some fractures that can very easily be treated closed, such as fractures near the jaw joint called condyle fractures.
Other fractures that are more severe and where the bones are out of alignment (displaced fractures) may require an open approach to repair them adequately.
Nasal bone fractures
A broken nose can also be treated closed if they are relatively ‘fresh.’ In the case of nasal fractures, sometimes the best option is to wait and repair the fracture in a delayed manner once all the swelling has dissipated.
Nasal bone fractures are usually characterized by a nose bleed, difficulty breathing through the nose, and deviation of the dorsum (ridge) of the nose. The nasal bone is the most-commonly fractured bone of the face.
Fractures of the orbit or eye socket
Fractures of the orbit or eye socket actually involve several bones, including the zygoma (cheek bone) and the maxilla (upper jaw). The signs and symptoms of this type of fracture known as a ZMC fracture (zygomaticomaxillary complex fracture) include: numbness of the cheek, depression of the cheek bone, bloody nose, double vision, difficulty opening the mouth, blood in the white part of the eye and, of course, swelling and bruising around the eye.
The treatment may be open or closed, depending on the severity of the signs and symptoms and the x-ray images. Bone plates have greatly helped in treating this type of injury.
Mandible (lower jaw) fractures
Mandible (lower jaw) fractures have certain signs and symptoms that help with the diagnosis too: numbness of the lower lip, malocclusion (bad bite), tooth pain, TMJ pain, difficulty opening the mouth, blood in the mouth, loose teeth, swelling, and bruising. One classic sign is bruising under the tongue.
The treatment may be open or closed, depending on the amount of displacement of the fracture. But the main goal is to re-establish a normal bite.
In fact, establishing the bite is the key to making sure the bones are in proper position before any stabilization is applied, such as wires, bone plates, and screws. Wiring the teeth into proper position for four to six weeks may be necessary to help stabilize the bones during the healing phase.
Most patients are placed on a liquid, non-chew diet until the bones have healed. Occasionally, additional surgery or orthodontics may be necessary to correct any residual bite problems.
Maxillary (upper jaw) fractures
Maxillary (upper jaw) fractures, or midface fractures, can also affect the bite. There may also be bleeding from the nose and signs of fractures of the bones around the eyes. This type of trauma is most typically associated with high-speed motor vehicle accidents as the face hits the dashboard or steering wheel. Airbags and seatbelts has greatly reduced the number and severity of these types of injuries.
Sometimes the midface injury can also be associated with a skull base fracture. This is usually treated only with antibiotics to prevent infection. But the maxillary fracture itself must be treated by restoring the bite, realigning the bones and fixing them in the correct position.
Almost all the open surgeries to treat facial fractures can be performed so that the incisions are hidden, for example, on the inside of the mouth or in a region, like under the jawline, or in a lower eyelid crease, like an eyelid lift.
Most of the time, the operation is performed in a hospital operating room under a general anesthetic. The recovery varies, depending on the severity and number of fractures.
Fractures of the teeth and teeth that are knocked out may cause loss of the involved teeth. If a tooth is knocked out for more than 45 minutes it is unlikely that it can be replaced back in the bone and saved.
There are several steps to take that may help improve the chances for saving the tooth. First, rinse it off with cold water or milk. If the patient is awake and able to tolerate it, the tooth can be pushed into the socket or held in the patients’ mouth.
The tooth may also be wrapped in a damp towel with ice or a milk dampened towel with ice and placed in a plastic bag for transport. A glass of milk to transport the tooth is also acceptable but not a glass of water.
If bone is lost around the tooth, then the chances for saving it decrease. The tooth must be stabilized like any fracture for several weeks until it reattaches its fibers to the bone. But it should not be stabilized too long so that it does not fuse to the bone. Fusion to the bone is one of the risks of replacing the tooth.
If the tooth does survive it will need a root canal and a crown to preserve it. Of course, if it cannot be saved then a dental implant can be inserted after the initial healing.
If You Need Surgery for Facial Trauma
The treatment of facial fractures involves:
- understanding the mechanism of the injury
- the relationship of the anatomy
- the management of putting bone, muscle, and skin back into their right location with minimal scarring
Patients often underestimate the impact of trauma’s long term effects. It’s important to get things back in the right position as close as possible the first time. Nevertheless, most patients with facial fractures will have a successful outcome without the need for revision surgery.
Get Help Now
It’s imperative you speak to a maxillofacial surgeon in Denver, CO like Dr. Robinson as soon as possible to deal with a condition caused by facial trauma. Call our office to schedule an appointment today.